期刊
PEDIATRIC INFECTIOUS DISEASE JOURNAL
卷 33, 期 6, 页码 623-629出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/INF.0000000000000223
关键词
pediatric HIV; opportunistic infection; morbidity; mortality
资金
- National Institutes of Health through the International Epidemiologic Databases to Evaluate AIDS (IeDEA)
- International Maternal Pediatric Adolescent AIDS Clinical Trials Group (IMPAACT)
- National Institute of Allergy and Infectious Disease (NIAID) [K01 AI078754, R01 AI058736]
- President's Emergency Fund for AIDS Relief (PEPfAR)
- Elizabeth Glaser Pediatric AIDS Foundation
- NIAID
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
- National Cancer Institute [U01 AI069911]
- NIAID [U01 AI068632]
- Eunice Kennedy Shriver NICHD
- National Institute of Mental Health (NIMH) [AI068632]
- Statistical and Data Analysis Center at Harvard School of Public Health, under the NIAID [5 U01 AI41110]
- Pediatric AIDS Clinical Trials Group (PACTG) [1 U01 AI068616]
- IMPAACT Group
- NICHD International and Domestic Pediatric and Maternal HIV Clinical Trials Network - NICHD [N01-DK-9-001/HHSN267200800001C]
Background: Few studies have reported CD4%- and age-stratified rates of World Health Organization Stage 3 (WHO3) events, World Health Organization Stage 4 (WHO4) events, tuberculosis (TB) and mortality in HIV-infected infants before initiation of antiretroviral therapy. Methods: HIV-infected children enrolled before 1 year of age in the International Epidemiologic Databases to Evaluate AIDS East Africa region (October 1, 2002, to November, 2008) were included. We estimated incidence rates of earliest clinical event (WHO3, WHO4 and TB), before antiretroviral therapy initiation per local guidelines, stratified by current age (< or >= 6 months) and current CD4% (<15%, 15-24%, >= 25%). CD4%-stratified mortality rates were estimated separately for children who did not experience a clinical event (background mortality) and for children who experienced an event, including acute mortality (<= 30 days post event) and later mortality (>30 days post event). Results: Among 847 children (median enrollment age: 4.8 months; median pre-antiretroviral therapy follow up: 10.8 months; 603 (71%) with >= 1 CD4% recorded), event rates were comparable for those aged <6 and >= 6 months. Current CD4% was associated with risk of WHO4 events for children <6 months of age and with all evaluated events for children >= 6 months old (P < 0.05). Background mortality was 3.7-8.4/100 person-years (PY). Acute mortality (<= 30 days post event) was 33.8/100 PY (after TB) and 41.1/100 PY (after WHO3 or WHO4). Later mortality (>30 days post event) ranged by CD4% from 4.7 to 29.1/100 PY. Conclusions: In treatment-naive, HIV-infected infants, WHO3, WHO4 and TB events were common before and after 6 months of age and led to substantial increases in mortality. Early infant HIV diagnosis and treatment are critically important, regardless of CD4%.
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