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

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dc.citation.volume182
dc.contributor.authorLuque, Marco T.
dc.contributor.authorJenkins, Cathy A.
dc.contributor.authorShepherd, Bryan E.
dc.contributor.authorPadgett, Denis
dc.contributor.authorRouzier, Vanessa
dc.contributor.authorSucci, Regina Celia M. [UNIFESP]
dc.contributor.authorMachado, Daisy M. [UNIFESP]
dc.contributor.authorMcGowan, Catherine C.
dc.contributor.authorVermund, Sten H.
dc.contributor.authorPinto, Jorge A.
dc.coverageNew York
dc.date.accessioned2020-07-17T14:02:54Z
dc.date.available2020-07-17T14:02:54Z
dc.date.issued2017
dc.description.abstractObjectives 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-naive, perinatally infected children who started cART age when they were younger than 18 years of age (median 4.7 yearsen
dc.description.abstractIQR 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 ageen
dc.description.abstract19% began a protease inhibitor. At cART initiation, median CD4 count was 472 cells/mm3 (IQR 201-902)en
dc.description.abstractmedian 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.en
dc.description.affiliationSocial Secur Honduran Inst, Dept Pediat, Tegucigalpa, Honduras
dc.description.affiliationVanderbilt Univ, Sch Med, Dept Biostat, Nashville, TN 37212 USA
dc.description.affiliationVanderbilt Univ, Sch Med, Dept Med, Nashville, TN 37212 USA
dc.description.affiliationVanderbilt Univ, Sch Med, Dept Pediat, Nashville, TN 37212 USA
dc.description.affiliationVanderbilt Inst Global Hlth, Nashville, TN USA
dc.description.affiliationHaitian Grp Studies Kaposi Sarcoma & Opportunist, Port Au Prince, Haiti
dc.description.affiliationUniv Fed Sao Paulo, Sch Med, Dept Pediat, Sao Paulo, Brazil
dc.description.affiliationUniv Fed Minas Gerais, Sch Med, Dept Pediat, Belo Horizonte, MG, Brazil
dc.description.affiliationUnifespUniv Fed Sao Paulo, Sch Med, Dept Pediat, Sao Paulo, Brazil
dc.description.sourceWeb of Science
dc.description.sponsorshipNational Institute of Allergy and Infectious Diseases
dc.description.sponsorshipEunice Kennedy Shriver National Institute of Child Health and Human Development
dc.description.sponsorshipNational Cancer Institute through Vanderbilt University School of Medicine
dc.description.sponsorshipIDNational Cancer Institute through Vanderbilt University School of Medicine: U01 AI069923
dc.format.extent245-252
dc.identifierhttp://dx.doi.org/10.1016/j.jpeds.2016.12.034
dc.identifier.citationJournal Of Pediatrics. New York, v. 182, p. 245-252, 2017.
dc.identifier.doi10.1016/j.jpeds.2016.12.034
dc.identifier.issn0022-3476
dc.identifier.urihttps://repositorio.unifesp.br/handle/11600/55082
dc.identifier.wosWOS:000396252400040
dc.language.isoeng
dc.publisherMosby-Elsevier
dc.relation.ispartofJournal Of Pediatrics
dc.rightsinfo:eu-repo/semantics/openAccess
dc.titleMortality in Children with Human Immunodeficiency Virus Initiating Treatment: A Six-Cohort Study in Latin Americaen
dc.typeinfo:eu-repo/semantics/article
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