Temporal Trends in the Characteristics of Children at Antiretroviral Therapy Initiation in Southern Africa: The IeDEA-SA Collaboration

Since 2005, increasing numbers of children have started antiretroviral therapy (ART) in sub-Saharan Africa and, in recent years, WHO and country treatment guidelines have recommended ART initiation for all infants and very young children, and at higher CD4 thresholds for older children. We examined...

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Vydané v:	PloS one Ročník 8; číslo 12; s. e81037
Hlavní autori:	Davies, Mary-Ann, Phiri, Sam, Wood, Robin, Wellington, Maureen, Cox, Vivian, Bolton-Moore, Carolyn, Timmerman, Venessa, Moultrie, Harry, Ndirangu, James, Rabie, Helena, Technau, Karl, Giddy, Janet, Maxwell, Nicola, Boulle, Andrew, Keiser, Olivia, Egger, Matthias, Eley, Brian
Médium:	Journal Article
Jazyk:	English
Vydavateľské údaje:	United States Public Library of Science 09.12.2013 Public Library of Science (PLoS)
Predmet:	Acquired immune deficiency syndrome Africa, Southern - epidemiology Age AIDS Anemia Anemia - epidemiology Anemia - etiology Anti-HIV Agents - therapeutic use Antiretroviral agents Antiretroviral drugs Antiretroviral therapy CD4 antigen CD4 Lymphocyte Count Child Child health Child, Preschool Children Collaboration Continuity (mathematics) Databases, Factual Diagnostic systems Female Guidelines Highly active antiretroviral therapy HIV HIV Infections - complications HIV Infections - drug therapy HIV Infections - epidemiology HIV Infections - immunology HIV tests Human immunodeficiency virus Humans Immunodeficiency Immunosuppression Immunotherapy Infant Infants Logistic Models Male Medical diagnosis Mortality Preventive medicine Regression analysis Therapy Time Factors Africa, Southern South Africa Zambia
ISSN:	1932-6203, 1932-6203
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Shrnutí:	Since 2005, increasing numbers of children have started antiretroviral therapy (ART) in sub-Saharan Africa and, in recent years, WHO and country treatment guidelines have recommended ART initiation for all infants and very young children, and at higher CD4 thresholds for older children. We examined temporal changes in patient and regimen characteristics at ART start using data from 12 cohorts in 4 countries participating in the IeDEA-SA collaboration. Data from 30,300 ART-naïve children aged <16 years at ART initiation who started therapy between 2005 and 2010 were analysed. We examined changes in median values for continuous variables using the Cuzick's test for trend over time. We also examined changes in the proportions of patients with particular disease severity characteristics (expressed as a binary variable e.g. WHO Stage III/IV vs I/II) using logistic regression. Between 2005 and 2010 the number of children starting ART each year increased and median age declined from 63 months (2006) to 56 months (2010). Both the proportion of children <1 year and ≥10 years of age increased from 12 to 19% and 18 to 22% respectively. Children had less severe disease at ART initiation in later years with significant declines in the percentage with severe immunosuppression (81 to 63%), WHO Stage III/IV disease (75 to 62%), severe anemia (12 to 7%) and weight-for-age z-score<-3 (31 to 28%). Similar results were seen when restricting to infants with significant declines in the proportion with severe immunodeficiency (98 to 82%) and Stage III/IV disease (81 to 63%). First-line regimen use followed country guidelines. Between 2005 and 2010 increasing numbers of children have initiated ART with a decline in disease severity at start of therapy. However, even in 2010, a substantial number of infants and children started ART with advanced disease. These results highlight the importance of efforts to improve access to HIV diagnostic testing and ART in children.
Bibliografia:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 Competing Interests: The authors have declared that no competing interests exist. Membership of the IeDEA Southern Africa Steering Group is provided in the Acknowledgments. Conceived and designed the experiments: MD SP RW MW VC CB VT HM JN HR KT JG NM AB OK ME BE. Performed the experiments: MD SP RW MW VC CB VT HM JN HR KT JG NM AB OK ME BE. Analyzed the data: MD AB NM BE. Wrote the paper: MD SP RW MW VC CB VT HM JN HR KT JG NM AB OK ME BE.
ISSN:	1932-6203 1932-6203
DOI:	10.1371/journal.pone.0081037