Early mortality and loss to follow-up in HIV-infected children starting antiretroviral therapy in Southern Africa.
Early mortality and loss to follow-up in HIV-infected children starting antiretroviral therapy in Southern Africa.
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DOI：
10.1097/qai.0b013e3181e0c4cf
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发表时间：
2010-08
期刊：
影响因子：
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通讯作者：
International epidemiologic Databases to Evaluate AIDS in Southern Africa
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文献类型：
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作者：
Fenner L;Brinkhof MW;Keiser O;Weigel R;Cornell M;Moultrie H;Prozesky H;Technau K;Eley B;Vaz P;Pascoe M;Giddy J;Van Cutsem G;Wood R;Egger M;Davies MA;International epidemiologic Databases to Evaluate AIDS in Southern Africa
南部非洲许多感染艾滋病毒的儿童已开始接受抗逆转录病毒治疗，但失访可能很严重。我们分析了继续接受护理的儿童和所有开始ART的儿童的死亡率，并将LTFU考虑在内。在南非、马拉维、莫桑比克和津巴布韦的10个抗逆转录病毒治疗方案中，16岁以前开始抗逆转录病毒治疗的儿童被包括在内。在威布尔模型中确定了ART第一年死亡的风险因素。采用荟萃分析方法估计1年时的累积死亡率。纳入8225名儿童（中位年龄49个月，中位CD 4细胞百分比11.6%）; 391名（4.8%）死亡，523名（7.0%）在第一年发生LTFU。考虑到儿童死亡率和LTFU后，继续接受护理的儿童一年死亡率为4.5%（95% CI 2.8-7.4%），但在计划水平为8.7%（5.4-12.1%）。与继续接受照料的儿童死亡率有关的因素包括年龄（校正风险比[HR] 0.37; 95% CI 0.25-0.54，比较≥120个月与<18个月），CD 4细胞百分比（HR 0.56; 95% CI 0.39-0.78，比较≥ 20%与<10%）和临床分期（HR 0.12; 95% CI 0.03-0.45，比较WHO I期与III/IV期）。在南部非洲开始抗逆转录病毒治疗并继续接受治疗的儿童中，一年死亡率<5%，但在方案一级，如果考虑长期治疗不足，死亡率几乎是方案一级的两倍。在个体水平上，年龄、CD 4百分比和临床分期是死亡率的重要预测因素。
Many HIV-infected children in Southern Africa have been started on antiretroviral therapy (ART), but loss to follow up (LTFU) can be substantial. We analyzed mortality in children retained in care and in all children starting ART, taking LTFU into account. Children who started ART before the age of 16 years in ten ART programs in South Africa, Malawi, Mozambique and Zimbabwe were included. Risk factors for death in the first year of ART were identified in Weibull models. A meta-analytic approach was used to estimate cumulative mortality at one year. 8225 children (median age 49 months, median CD4 cell percent 11.6%) were included; 391 (4.8%) died and 523 (7.0%) were LTFU in the first year. Mortality at one year was 4.5% (95% CI 2.8–7.4%) in children remaining in care, but 8.7% (5.4–12.1%) at the program level, after taking mortality in children and LTFU into account. Factors associated with mortality in children remaining in care included age (adjusted hazard ratio [HR] 0.37; 95% CI 0.25–0.54 comparing ≥120 months with <18 months), CD4 cell percent (HR 0.56; 95% CI 0.39–0.78 comparing ≥ 20% with <10%), and clinical stage (HR 0.12; 95% CI 0.03–0.45 comparing WHO stage I with III/IV). In children starting ART and remaining in care in Southern Africa mortality at one year is <5% but almost twice as high at the program level, when taking LTFU into account. Age, CD4 percentage and clinical stage are important predictors of mortality at the individual level.