Long-term survival of HIV-infected children receiving antiretroviral therapy in Thailand: a 5-year observational cohort study
type: Article
item type: journalArticle
is part of: Clin Infect Dis
authors: Person
  surname: Collins
  given name: Intira
authors: Person
  surname: Jourdain
  given name: Gonzague
authors: Person
  surname: Hansudewechakul
  given name: Rawiwan
authors: Person
  surname: Kanjanavanit
  given name: Suparat
authors: Person
  surname: Hongsiriwon
  given name: Suchat
authors: Person
  surname: Ngampiyasakul
  given name: Chaiwat
authors: Person
  surname: Sriminiphant
  given name: Somboon
authors: Person
  surname: Technakunakorn
  given name: Pornchai
authors: Person
  surname: Ngo-Giang-Huong
  given name: Nicole
authors: Person
  surname: Duong
  given name: Trinh
authors: Person
  surname: Le Cœur
  given name: Sophie
authors: Person
  surname: Jaffar
  given name: Shabbar
authors: Person
  surname: Lallemant
  given name: Marc
subject: Anti-HIV Agents/ therapeutic use
subject: Antiretroviral Therapy, Highly Active
subject: Child
subject: Child, Preschool
subject: Cohort Studies
subject: Female
subject: Follow-Up Studies
subject: HIV Infections/ drug therapy/ mortality
subject: Humans
subject: Infant
subject: Male
subject: Prospective Studies
subject: Survival Analysis
subject: Thailand
subject: Time Factors
abstract: BACKGROUND: There are scarce data on the long-term survival of human immunodeficiency virus (HIV)-infected children receiving antiretroviral therapy (ART) in lower-middle income countries beyond 2 years of follow-up. METHODS: Previously untreated children who initiated ART on meeting immunological and/or clinical criteria were followed in a prospective cohort in Thailand. The probability of survival up to 5 years from initiation was estimated using Kaplan-Meier methods, and factors associated with mortality were assessed using Cox regression analyses. RESULTS: Five hundred seventy-eight children received ART; of these, 111 (19.2%) were followed since birth. At start of ART (baseline), the median age was 6.7 years, 128 children (22%) were aged <2 years, and the median CD4 cell percentage was 7%. Median duration of follow-up was 53 months; 42 children (7%) died, and 38 (7%) were lost to follow-up. Age <12 months, low CD4 cell percentage, and low weight-for-height z score at ART initiation were independently associated with mortality (P < .001). The probability of survival among infants aged <12 months at baseline was 84.3% at 1 year and 76.7% at 5 years of ART, compared with 95.7% and 94.8%, respectively, among children aged >/=1 year. Low CD4 cell percentage and wasting at baseline had a strong association with mortality among older children but weak or no association among infants. CONCLUSIONS: Children who initiated ART as infants after meeting immunological and/or clinical criteria had a high risk of mortality which persisted beyond the first year of therapy. Among older children, those with severe wasting or low CD4 cell percentage at treatment initiation were at high risk of mortality during the first 6 months of therapy. These findings support the scale-up of early HIV diagnosis and immediate treatment in infants, before advanced disease progression in older children.
date: 2010
pages: 1449-57
citation key: collinsLongtermSurvivalHIVinfected2010
short title: Long-term survival of HIV-infected children receiving antiretroviral therapy in Thailand: a 5-year observational cohort study
description: 12

Clin Infect Dis
type: Journal
volume: 51
identifier: DOI 10.1086/657401
identifier: ISSN 1537-6591 (Electronic) 1058-4838 (Linking)