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J Pediatr. 2017 Mar;182:245-252.e1. doi: 10.1016/j.jpeds.2016.12.034. Epub 2017 Jan 9.

Mortality in Children with Human Immunodeficiency Virus Initiating Treatment: A Six-Cohort Study in Latin America.

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Department of Pediatrics, Social Security Honduran Institute, Tegucigalpa, Honduras.
Departments of Biostatistics, Medicine, and Pediatrics, Vanderbilt University School of Medicine, and Vanderbilt Institute for Global Health, Nashville, TN.
Haitian Group for Studies of Kaposi Sarcoma and Opportunistic Infections, Port-au-Prince, Haiti.
Department of Pediatrics, School of Medicine, Federal University of São Paulo, São Paulo, Brazil.
Department of Pediatrics, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil. Electronic address:



To assess the risks of and factors associated with mortality, loss to follow-up, and changing regimens after children with HIV infected perinatally initiate combination antiretroviral therapy (cART) in Latin America and the Caribbean.


This 1997-2013 retrospective cohort study included 1174 antiretroviral therapy-naïve, perinatally infected children who started cART age when they were younger than 18 years of age (median 4.7 years; IQR 1.7-8.8) at 1 of 6 cohorts from Argentina, Brazil, Haiti, and Honduras, within the Caribbean, Central and South America Network for HIV Epidemiology. Median follow-up was 5.6 years (IQR 2.3-9.3). Study outcomes were all-cause mortality, loss to follow-up, and major changes in cART. We used Cox proportional hazards models stratified by site to examine the association between predictors and times to death or changing regimens.


Only 52% started cART at younger than 5 years of age; 19% began a protease inhibitor. At cART initiation, median CD4 count was 472 cells/mm3 (IQR 201-902); median CD4% was 16% (IQR 10-23). Probability of death was high in the first year of cART: 0.06 (95% CI 0.04-0.07). Five years after cART initiation, the cumulative mortality incidence was 0.12 (95% CI 0.10-0.14). Cumulative incidences for loss to follow-up and regimen change after 5 years were 0.16 (95% 0.14-0.18) and 0.30 (95% 0.26-0.34), respectively. Younger children had the greatest risk of mortality, whereas older children had the greatest risk of being lost to follow-up or changing regimens.


Innovative clinical and community approaches are needed for quality improvement in the pediatric care of HIV in the Americas.


HIV/AIDS; infectious diseases

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