Early Antiretroviral Therapy Initiation and Mortality Among Infants Diagnosed With HIV in the First 12 Weeks of Life
| Autor: | Annelies Van Rie, Frieda Behets, Robert S. Heyderman, Anna D. Sheahan, Emily R. Smith, Queen Dube, Chawanangwa Chirambo, Andrew Edmonds, Lydia Feinstein |
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| Rok vydání: | 2017 |
| Předmět: |
Male
0301 basic medicine Microbiology (medical) Malawi Pediatrics medicine.medical_specialty Population HIV Infections Article Time-to-Treatment Cohort Studies 03 medical and health sciences 0302 clinical medicine Interquartile range Humans Medicine Cumulative incidence 030212 general & internal medicine education education.field_of_study business.industry Incidence (epidemiology) Infant 030112 virology Infant mortality Early Diagnosis Infectious Diseases Clinical research Anti-Retroviral Agents Pediatrics Perinatology and Child Health Cohort Democratic Republic of the Congo Female business Cohort study |
| Zdroj: | Pediatric Infectious Disease Journal. 36:654-658 |
| ISSN: | 0891-3668 |
| DOI: | 10.1097/inf.0000000000001539 |
| Popis: | Background Based on clinical trial results, the World Health Organization recommends infant HIV testing at age 4-6 weeks and immediate antiretroviral therapy (ART) initiation in all HIV-infected infants. Little is known about the outcomes of HIV-infected infants diagnosed with HIV in the first weeks of life in resource-limited settings. We assessed ART initiation and mortality in the first year of life among infants diagnosed with HIV by 12 weeks of age. Methods Cohort of HIV-infected infants in Kinshasa and Blantyre diagnosed before 12 weeks to estimate 12-month cumulative incidences of ART initiation and mortality, accounting for competing risks. Multivariate models were used to estimate associations between infant characteristics and timing of ART initiation. Results One hundred and twenty-one infants were diagnosed at a median age of 7 weeks (interquartile range, 6-8). The cumulative incidence of ART initiation was 46% [95% confidence interval (CI), 36%, 55%] at 6 months and 70% (95% CI 60%, 78%) at 12 months. Only age at HIV diagnosis was associated with ART initiation by age 6 months, with a subdistribution hazard ratio of 0.70 (95% CI 0.52, 0.91) for each week increase in age at DNA polymerase chain reaction test. The 12-month cumulative incidence of mortality was 20% (95% CI 13%, 28%). Conclusions Despite early diagnosis of HIV, ART initiation was slow and mortality remained high, underscoring the complexity in translating clinical trial findings and World Health Organization's guidance into real-life practice. Novel and creative health system interventions will be required to ensure that all HIV-infected infants achieve optimal treatment outcomes under routine care settings. |
| Databáze: | OpenAIRE |
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