Sheahan, A;
Feinstein, L;
Dube, Q;
Edmonds, A;
Chirambo, CM;
Smith, E;
Behets, F;
... Van Rie, A; + view all
(2017)
Early Antiretroviral Therapy Initiation and Mortality Among Infants Diagnosed with HIV in the First 12 Weeks of Life.
Pediatric Infectious Disease Journal
, 36
(7)
pp. 654-658.
10.1097/INF.0000000000001539.
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Abstract
AB Background: Based on clinical trial results, the WHO recommends infant HIV testing at age 4-6 weeks and immediate antiretroviral therapy (ART) initiation in all HIV-infected infants. Little is known about the outcomes of HIV infected infants diagnosed with HIV in the first weeks of life in resource-limited settings. We assessed ART initiation and mortality in the first year of life among infants diagnosed with HIV by 12 weeks of age. Methods: Cohort of HIV-infected infants in Kinshasa and Blantyre diagnosed before 12 weeks to estimate 12-month cumulative incidences of ART initiation and mortality, accounting for competing risks. Multivariate models were used to estimate associations between infant characteristics and timing of ART initiation. Results: 121 infants were diagnosed at a median age of 7 weeks (interquartile range 6-8). The cumulative incidence of ART initiation was 46% (95% CI: 36%, 55%) at 6 months and 70% (95% CI: 60%, 78%) at 12 months. Only age at HIV diagnosis was associated with ART initiation by age 6 months, with a subdistribution hazard ratio of 0.70 (95% CI: 0.52, 0.91) for each week increase in age at DNA PCR test. The 12-month cumulative incidence of mortality was 20% (95% CI: 13%, 28%). Conclusions: Despite early diagnosis of HIV, ART initiation was slow and mortality remained high, underscoring the complexity in translating clinical trial findings and WHO guidance into real-life practice. Novel and creative health system interventions will be required to ensure that all HIV infected infants achieve optimal treatment outcomes under routine care settings.
| Type: | Article |
|---|---|
| Title: | Early Antiretroviral Therapy Initiation and Mortality Among Infants Diagnosed with HIV in the First 12 Weeks of Life |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1097/INF.0000000000001539 |
| Publisher version: | https://doi.org/10.1097/INF.0000000000001539 |
| Language: | English |
| Additional information: | Copyright © 2016 Wolters Kluwer Health, Inc. This is the accepted manuscript version of this article published in Pediatric Infectious Disease Journal; the final published version of record can be found at http://dx.doi.org/10.1097/INF.0000000000001539. |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Infection and Immunity |
| URI: | https://discovery.ucl.ac.uk/id/eprint/1538748 |
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