Short-Term Risk of HIV-Disease Progression and Death in Ugandan Children Not Eligible for Antiretroviral Therapy
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Date
2010
Journal Title
Journal ISSN
Volume Title
Publisher
Journal of acquired immune deficiency syndromes
Abstract
Background—Increasing numbers of HIV-infected children not yet eligible for antiretroviral
therapy (ART) are entering health care in Africa. We sought to characterize the risk of short-term
disease progression in this population.
Methods—In a cohort of HIV-infected ART-naive and -ineligible Ugandan children >1 year old,
the rates of clinical/immunologic progression within 2 years were assessed using Kaplan–Meier
survival analysis and multivariate Cox proportional-hazards modeling.
Results—Among 192 children (mean age: 6.4 years, CD4%:25), 19% progressed within 2 years
by WHO-stage 3/4 event(n=22), death (n=3), or WHO-defined CD4 threshold for ARTinitiation(
n=12). Significant univariate predictors were CD4%(HR=2.0 per 10% decrease,
p=0.005), HIV-RNA level(HR=2.4 per log10 increase, p=0.002), male gender (HR:2.0, p=0.04),
age < 3 years (HR=3.7, p=0.001), CD4-activation [%CD4+CD38+HLADR+] (HR=1.6 per 10%
increase, p=0.05) and CD8-activation [%CD8+CD38+HLADR+](HR=1.3 per 10% increase,
p=0.05] (HR=1.3, p=0.5). In multivariate analysis, CD4%(HR=2.0, p=0.034), HIV-RNA
level(HR=1.8, p=0.013) and age < 3 years (HR:3.0, p=0.008) were independently predictive.
Children with HIV-RNA >105 copies/ml and CD4% <25 had progression rates of 29% (1 year)
and 34% (2 years).
Conclusions—Even with frequent CD4 monitoring, HIV-infected Ugandan children
experienced significant clinical events while ineligible for ART. Alternate strategies for
monitoring or ART-initiation may be needed to improve outcomes
Description
Keywords
HIV, Children, Progression, Monitoring, Resource-limited
Citation
Charlebois, E. D., Ruel, T. D., Gasasira, A. F., Achan, J., Kateera, F., Akello, C., ... & Havlir, D. V. (2010). Short-Term Risk of HIV-Disease Progression and Death in Ugandan Children Not Eligible for Antiretroviral Therapy. Journal of acquired immune deficiency syndromes (1999), 55(3), 330.doi:10.1097/QAI.0b013e3181e583da.