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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.

Author information

  • 1Department of Pediatrics, Social Security Honduran Institute, Tegucigalpa, Honduras.
  • 2Departments of Biostatistics, Medicine, and Pediatrics, Vanderbilt University School of Medicine, and Vanderbilt Institute for Global Health, Nashville, TN.
  • 3Haitian Group for Studies of Kaposi Sarcoma and Opportunistic Infections, Port-au-Prince, Haiti.
  • 4Department of Pediatrics, School of Medicine, Federal University of São Paulo, São Paulo, Brazil.
  • 5Department of Pediatrics, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil. Electronic address: jpinto@medicina.ufmg.br.

Abstract

OBJECTIVES:

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.

STUDY DESIGN:

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.

RESULTS:

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.

CONCLUSIONS:

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

KEYWORDS:

HIV/AIDS; infectious diseases

PMID:
28081884
DOI:
10.1016/j.jpeds.2016.12.034
[PubMed - in process]
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