期刊
JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES
卷 68, 期 1, 页码 62-72出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/QAI.0000000000000380
关键词
children; antiretroviral; immunodeficiency; CD4; global
资金
- National Cancer Institute (NCI)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
- National Institute of Allergy And Infectious Diseases (NIAID) as part of the International epidemiologic Databases to Evaluate AIDS (IeDEA) [5U01AI069919-04, 5U01-AI069924-05, 1U01 AI069927, U01AI069911-01]
- AIDS Life Austria
- NIAID
- NICHD
- NCI as part of IeDEA [U01AI069907]
- Australian Government Department of Health and Aging
- Faculty of Medicine, University of New South Wales
- NIH
- NICHD [N01-HD-3-3345, N01-HD-8-0001]
- Eunice Kennedy Shriver National Institute of Child Health and Human Development
- National Institute on Drug Abuse, the National Institute of Allergy and Infectious Diseases
- Office of AIDS Research
- National Institute of Mental Health
- National Institute of Neurological Disorders and Stroke
- National Institute on Deafness and Other Communication Disorders
- National Heart Lung and Blood Institute
- National Institute of Dental and Craniofacial Research
- National Institute on Alcohol Abuse and Alcoholism
- Harvard University School of Public Health [HD052102, 3 U01 HD052102-05S1, 3 U01 HD052102-06S3]
- Tulane University School of Medicine [HD052104, 3U01HD052104-06S1]
- NIAID [U01 AI068632, N01-3-3345, HHSN267200800001C]
- Statistical and Data Analysis Center at Harvard School of Public Health under NIAID [5 U01 AI41110]
- Pediatric AIDS Clinical Trials Group (PACTG) [1 U01 AI068616]
- IMPAACT Group
- EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE OF CHILD HEALTH & HUMAN DEVELOPMENT [U01HD052102, U01HD052104] Funding Source: NIH RePORTER
- EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE OF CHILD HEALTH &HUMAN DEVELOPMENT [N01HD033345] Funding Source: NIH RePORTER
- NATIONAL CENTER FOR ADVANCING TRANSLATIONAL SCIENCES [UL1TR001082] Funding Source: NIH RePORTER
- NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES [U01AI069927, U01AI069924, U01AI069919, UM1AI068616, U01AI041110, U01AI068632, U01AI068616, U01AI069911, U01AI069907, UM1AI068632] Funding Source: NIH RePORTER
Background: The CD4 cell count or percent (CD4%) at the start of combination antiretroviral therapy (cART) is an important prognostic factor in children starting therapy and an important indicator of program performance. We describe trends and determinants of CD4 measures at cART initiation in children from low-, middle-, and high-income countries. Methods: We included children aged <16 years from clinics participating in a collaborative study spanning sub-Saharan Africa, Asia, Latin America, and the United States. Missing CD4 values at cART start were estimated through multiple imputation. Severe immunodeficiency was defined according to World Health Organization criteria. Analyses used generalized additive mixed models adjusted for age, country, and calendar year. Results: A total of 34,706 children from 9 low-income, 6 lower middle-income, 4 upper middle-income countries, and 1 high-income country (United States) were included; 20,624 children (59%) had severe immunodeficiency. In low-income countries, the estimated prevalence of children starting cART with severe immunodeficiency declined from 76% in 2004 to 63% in 2010. Corresponding figures for lower middle-income countries were from 77% to 66% and for upper middle-income countries from 75% to 58%. In the United States, the percentage decreased from 42% to 19% during the period 1996 to 2006. In low-and middle-income countries, infants and children aged 12-15 years had the highest prevalence of severe immunodeficiency at cART initiation. Conclusions: Despite progress in most low-and middle-income countries, many children continue to start cART with severe immunodeficiency. Early diagnosis and treatment of HIV-infected children to prevent morbidity and mortality associated with immunodeficiency must remain a global public health priority.
作者
我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。
推荐
暂无数据