Dataset Information

Optimal timing of antiretroviral treatment initiation in HIV-positive children and adolescents: a multiregional analysis from Southern Africa, West Africa and Europe.

ABSTRACT:

Background

There is limited knowledge about the optimal timing of antiretroviral treatment initiation in older children and adolescents.

Methods

A total of 20 576 antiretroviral treatment (ART)-naïve patients, aged 1-16 years at enrolment, from 19 cohorts in Europe, Southern Africa and West Africa, were included. We compared mortality and growth outcomes for different ART initiation criteria, aligned with previous and recent World Health Organization criteria, for 5 years of follow-up, adjusting for all measured baseline and time-dependent confounders using the g-formula.

Results

Median (1st;3rd percentile) CD4 count at baseline was 676 cells/mm 3 (394; 1037) (children aged ? 1 and < 5 years), 373 (172; 630) (? 5 and < 10 years) and 238 (88; 425) (? 10 and < 16 years). There was a general trend towards lower mortality and better growth with earlier treatment initiation. In children < 10 years old at enrolment, by 5 years of follow-up there was lower mortality and a higher mean height-for-age z-score with immediate ART initiation versus delaying until CD4 count < 350 cells/mm 3 (or CD4% < 15% or weight-for-age z-score < -2) with absolute differences in mortality and height-for-age z-score of 0.3% (95% confidence interval: 0.1%; 0.6%) and -0.08 (-0.09; -0.06) (? 1 and < 5 years), and 0.3% (0.04%; 0.5%) and -0.07 (-0.08; -0.05) (? 5 and < 10 years). In those aged > 10 years at enrolment we did not find any difference in mortality or growth with immediate ART initiation, with estimated differences of -0.1% (-0.2%; 0.6%) and -0.03 (-0.05; 0.00), respectively. Growth differences in children aged < 10 years persisted for treatment thresholds using higher CD4 values. Regular follow-up led to better height and mortality outcomes.

Conclusions

Immediate ART is associated with lower mortality and better growth for up to 5 years in children < 10 years old. Our results on adolescents were inconclusive.

SUBMITTER: Schomaker M

PROVIDER: S-EPMC5837574 | biostudies-literature | 2017 Apr

REPOSITORIES: biostudies-literature

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Publications

Optimal timing of antiretroviral treatment initiation in HIV-positive children and adolescents: a multiregional analysis from Southern Africa, West Africa and Europe.

Schomaker Michael M Leroy Valeriane V Wolfs Tom T Technau Karl-Günter KG Renner Lorna L Judd Ali A Sawry Shobna S Amorissani-Folquet Madeleine M Noguera-Julian Antoni A Tanser Frank F Eboua François F Navarro Maria Luisa ML Chimbetete Cleophas C Amani-Bosse Clarisse C Warszawski Josiane J Phiri Sam S N'Gbeche Sylvie S Cox Vivian V Koueta Fla F Giddy Janet J Sygnaté-Sy Haby H Raben Dorthe D Chêne Geneviève G Davies Mary-Ann MA

International journal of epidemiology 20170401 2

<h4>Background</h4>There is limited knowledge about the optimal timing of antiretroviral treatment initiation in older children and adolescents.<h4>Methods</h4>A total of 20 576 antiretroviral treatment (ART)-naïve patients, aged 1-16 years at enrolment, from 19 cohorts in Europe, Southern Africa and West Africa, were included. We compared mortality and growth outcomes for different ART initiation criteria, aligned with previous and recent World Health Organization criteria, for 5 years of follo ...[more]

PMID: 27342220

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Dataset Information

Optimal timing of antiretroviral treatment initiation in HIV-positive children and adolescents: a multiregional analysis from Southern Africa, West Africa and Europe.

Background

Methods

Results

Conclusions

Publications

Optimal timing of antiretroviral treatment initiation in HIV-positive children and adolescents: a multiregional analysis from Southern Africa, West Africa and Europe.

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