Excellent outcomes among HIV plus children on ART, but unacceptably high pre-ART mortality and losses to follow-up: a cohort study from Cambodia
Excellent outcomes among HIV plus children on ART, but unacceptably high pre-ART mortality and losses to follow-up: a cohort study from Cambodia
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DOI：
10.1186/1471-2431-9-54
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发表时间：
2009-08-20
期刊：
影响因子：
2.4
通讯作者：
Kumar, Varun
中科院分区：
文献类型：
--
作者：
Raguenaud, Marie-Eve;Isaakidis, Petros;Kumar, Varun
背景资料：虽然艾滋病毒项目评估侧重于ART的死亡率，但它们并没有评估艾滋病毒项目的整体表现，因为它们排除了符合条件但出于任何原因未开始ART的患者。本研究的目的是衡量死亡率，发生在ART前和ART期间，在两个HIV-program in Cambodia.Methods：回顾性队列研究1168 HIV-阳性儿童<15岁的两个HIV-program在四年内注册。结果：超过一半（53%）的儿童是5岁或以上，只有69（6%）是<18个月。总体而言，自方案设立以来，9%（105/1168）的儿童死亡。在观察期结束时，66（14.5%）未接受抗逆转录病毒治疗的患者死亡，66/105例患者中，100例（5.5%）正在接受抗逆转录病毒治疗，100例（22%）未开始抗逆转录病毒治疗，13例（2%）接受抗逆转录病毒治疗。所有项目内死亡的62.8%发生在开始ART之前，其中56%（37/66）和79%（52/66）分别发生在入组后3个月和6个月内。未接受抗逆转录病毒治疗儿童与接受抗逆转录病毒治疗儿童的死亡率比为4.1（95% CI：2.7 - 6.2）（P <0.001）。在治疗的前3个月和项目入组的前3个月，最常见的死亡原因是结核病。41/52（79%）的儿童谁在6个月内死亡的入学符合ART资格criteria before death. Conclusion：HIV阳性儿童经历了高死亡率和失访率开始ART。这些程序的结果可能会得到改善，更及时的ART启动。为了更准确地评估儿科HIV项目的绩效，建议测量总体项目中死亡率，而不仅仅是ART的死亡率。
Background: Although HIV program evaluations focusing on mortality on ART provide important evidence on treatment effectiveness, they do not asses overall HIV program performance because they exclude patients who are eligible but not started on ART for whatever reason. The objective of this study was to measure mortality that occurs both pre-ART and during ART among HIV-positive children enrolled in two HIV-programs in Cambodia.Methods: Retrospective cohort study on 1168 HIV-positive children < 15 years old registered in two HIV-programs over a four-year period. Mortality rates were calculated for both children on treatment and children not started on ART.Results: Over half (53%) of children were 5 years or above and only 69(6%) were < 18 months. Overall, 9% (105/1168) of children died since the set-up of the programs. By the end of the observation period, 66(14.5%) patients not on ART had died compared to 39(5.5%) of those under treatment, and 100(22%) who did not start ART were lost-to-follow-up compared to 13(2%) on ART. 66/105 (62.8%) of all in-program deaths occurred before starting ART, of which 56% (37/66) and 79% (52/66) occurred within 3 and 6 months of enrolment respectively. Mortality rate ratio between children not on ART and children on ART was 4.1 (95% CI: 2.7-6.2) (P < 0.001). The most common contributing cause of death in first 3 months of treatment and in first 3 months of program enrollment was tuberculosis. 41/52 (79%) children who died within 6 months of enrollment had met the ART eligibility criteria before death.Conclusion: HIV-positive children experienced a high mortality and loss-to-follow-up rates before starting ART. These program outcomes may be improved by a more timely ART initiation. Measuring overall in-program mortality as opposed to only mortality on ART is recommended in order to more accurately evaluate pediatric HIV-programs performance.