SOEDAK2009 --- PREPARE FOR THE LONG RUN

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Titel
Antiretroviral treatment outcomes and their predictors in a large cohort of HIV-Infected children in Sub-Saharan Africa
Autor
Maria Cristina Marazzi1, Andrea De Luca2, Massimo Magnano San Lio3, Ersilia Buonomo3, Paola Scarcella4, Paola Germano4, Gianni Guidotti4, Giovanna Paturzo4, An
Abstract
Background: Treatment of HIV-1 infected children in Sub-Saharan Africa is challenging.
Methods: Outcomes of ART-naive children (age ≤14y) from 17 Dream-supported public sites in Mozambique, Malawi and Guinea starting ART was investigated. Baseline hemoglobin (Hb), baseline and last available CD4 percentage, plasma HIV RNA (VL, bDNA), age-adjusted weight z-score (WAZ), and height z-score (HAZ) were retrieved for analysis. Predictors of time-to-death were analyzed by multivariable Cox regression.
Results: Of 2,215 children 52.3% were male; baseline median age was 4 years (IQR 2-8), mean CD4 16%, VL 5.2 log10 cp/mL, median WAZ -2.16 (-3.02, -1.28), HAZ -2.58 (-3.65, -1.55). Most regimens were based on a thymidine analogue+3TC+NVP. After a median follow-up of 67 weeks, mean change of CD4 percentage was +12, of WAZ +0.48 (95%CI +0.43; +0.53) and of HAZ +0.46 (95%CI +0.41; +0.51); VL was< 1,000 copies/mL in 878 of 1,357 with available data (64.7%). Among 1,410 children (63.7%) developing at least one clinical event, the first was gastrointestinal infection in 673 (30.4%), malaria in 476 (21.5%), tuberculosis in 158 (7.1%), pneumonia in 102 (4.6%); 897 (40.5%) experienced subsequent events. Overall, 238 children died and 63 were lost to follow-up. The 2-year estimated proportion surviving was 0.92. At univariable analysis, younger age, lower baseline Hb, CD4 percentage, WAZ and HAZ and higher baseline VL were associated with higher hazards for death. In a multivariable model only baseline VL (per log10 cp/mL higher, HR 1.22; 95%CI 1.04, 1.44) and baseline WAZ (per unit higher, HR 0.58; 0.52-0.64) were predictive of death.
Conclusions: In this cohort of HIV-infected children treated with ART in the Sub-Saharan African setting, treatment was followed by a high survival and retention rate. Immunological and growth parameters improved significantly. A high incidence of opportunistic or other infections and a significant proportion of suboptimal virological responses were observed.
Datei SOEDAK_09_OSA1.pdf