Growth and Mortality Outcomes for Different Antiretroviral Therapy Initiation Criteria in Children aged 1–5 Years: A Causal Modelling Analysis
Identifieur interne : 000379 ( Pmc/Corpus ); précédent : 000378; suivant : 000380Growth and Mortality Outcomes for Different Antiretroviral Therapy Initiation Criteria in Children aged 1–5 Years: A Causal Modelling Analysis
Auteurs : Michael Schomaker ; Mary-Ann Davies ; Karen Malateste ; Lorna Renner ; Shobna Sawry ; Sylvie N Beche ; Karl-Günter Technau ; François Eboua ; Frank Tanser ; Haby Sygnaté-Sy ; Sam Phiri ; Madeleine Amorissani-Folquet ; Vivian Cox ; Fla Koueta ; Cleophas Chimbete ; Annette Lawson-Evi ; Janet Giddy ; Clarisse Amani-Bosse ; Robin Wood ; Matthias Egger ; Valeriane LeroySource :
- Epidemiology (Cambridge, Mass.) [ 1044-3983 ] ; 2016.
Abstract
There is limited evidence regarding the optimal timing of initiating antiretroviral therapy (ART) in children. We conducted a causal modelling analysis in children aged 1–5 years from the International Epidemiologic Databases to Evaluate AIDS West/Southern-Africa collaboration to determine growth and mortality differences related to different CD4-based treatment initiation criteria, age groups and regions.
ART-naïve children of age 12–59 months at enrollment with at least one visit before ART initiation and one follow-up visit were included. We estimated 3-year growth and cumulative mortality from the start of follow-up for different CD4 criteria using g-computation.
About one quarter of the 5826 included children was from West Africa (24.6%). The median (first; third quartile) CD4% at the first visit was 16% (11%;23%), the median weight-for-age z-scores and height-for-age z-scores were −1.5 (−2.7; −0.6) and −2.5 (−3.5; −1.5), respectively. Estimated cumulative mortality was higher overall, and growth was slower, when initiating ART at lower CD4 thresholds. After 3 years of follow-up, the estimated mortality difference between starting ART routinely irrespective of CD4 count and starting ART if either CD4 count<750 cells/mm3 or CD4%<25% was 0.2% (95%CI: −0.2%;0.3%), and the difference in the mean height-for-age z-scores of those who survived was −0.02 (95%CI: −0.04;0.01). Younger children aged 1–2 and children in West Africa had worse outcomes.
Our results demonstrate that earlier treatment initiation yields overall better growth and mortality outcomes, though we could not show any differences in outcomes between immediate ART and delaying until CD4 count/% falls below750/25%.
Url:
DOI: 10.1097/EDE.0000000000000412
PubMed: 26479876
PubMed Central: 5410645
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id="A2">University of Bordeaux, Institute of Epidemiology and Public Health, Bordeaux, France</nlm:aff></affiliation></author><author><name sortKey="Renner, Lorna" sort="Renner, Lorna" uniqKey="Renner L" first="Lorna" last="Renner">Lorna Renner</name><affiliation><nlm:aff id="A3">University of Ghana Medical School, Accra, Ghana</nlm:aff></affiliation></author><author><name sortKey="Sawry, Shobna" sort="Sawry, Shobna" uniqKey="Sawry S" first="Shobna" last="Sawry">Shobna Sawry</name><affiliation><nlm:aff id="A4">University of the Witwatersrand, Wits Reproductive Health and HIV Institute, Harriet Shezi Children’s Clinic, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa</nlm:aff></affiliation></author><author><name sortKey="N Beche, Sylvie" sort="N Beche, Sylvie" uniqKey="N Beche S" first="Sylvie" last="N Beche">Sylvie N Beche</name><affiliation><nlm:aff id="A5">Centre de Prise en Charge de Recherche et de Formation Enfants, Abidjan, Côte d’Ivoire</nlm:aff></affiliation></author><author><name sortKey="Technau, Karl Gunter" sort="Technau, Karl Gunter" uniqKey="Technau K" first="Karl-Günter" last="Technau">Karl-Günter Technau</name><affiliation><nlm:aff id="A6">Empilweni Service and Research Unit, Rahima Moosa Mother and Child Hospital and University of the Witwatersrand, Johannesburg, South Africa</nlm:aff></affiliation></author><author><name sortKey="Eboua, Francois" sort="Eboua, Francois" uniqKey="Eboua F" first="François" last="Eboua">François Eboua</name><affiliation><nlm:aff id="A7">Yopougon University Hospital, Abidjan, Côte d’Ivoire</nlm:aff></affiliation></author><author><name sortKey="Tanser, Frank" sort="Tanser, Frank" uniqKey="Tanser F" first="Frank" last="Tanser">Frank Tanser</name><affiliation><nlm:aff id="A8">Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa</nlm:aff></affiliation></author><author><name sortKey="Sygnate Sy, Haby" sort="Sygnate Sy, Haby" uniqKey="Sygnate Sy H" first="Haby" last="Sygnaté-Sy">Haby Sygnaté-Sy</name><affiliation><nlm:aff id="A9">Albert Royer Hospital, Dakar, Senegal</nlm:aff></affiliation></author><author><name sortKey="Phiri, Sam" sort="Phiri, Sam" uniqKey="Phiri S" first="Sam" last="Phiri">Sam Phiri</name><affiliation><nlm:aff id="A10">Lighthouse Trust Clinic, Kamuzu Central Hospital, Lilongwe, Malawi</nlm:aff></affiliation><affiliation><nlm:aff id="A11">University of North Carolina, Chapel Hill, United States of America</nlm:aff></affiliation></author><author><name sortKey="Amorissani Folquet, Madeleine" sort="Amorissani Folquet, Madeleine" uniqKey="Amorissani Folquet M" first="Madeleine" last="Amorissani-Folquet">Madeleine Amorissani-Folquet</name><affiliation><nlm:aff id="A12">Félix Houphouët Boigny University Hospital, Abidjan, Côte d’Ivoire</nlm:aff></affiliation></author><author><name sortKey="Cox, Vivian" sort="Cox, Vivian" uniqKey="Cox V" first="Vivian" last="Cox">Vivian Cox</name><affiliation><nlm:aff id="A13">Médecins Sans Frontiéres South Africa, CapeTown, South Africa</nlm:aff></affiliation><affiliation><nlm:aff id="A14">Khayelitsha ART Programme, Khayelitsha, Cape Town, South Africa</nlm:aff></affiliation></author><author><name sortKey="Koueta, Fla" sort="Koueta, Fla" uniqKey="Koueta F" first="Fla" last="Koueta">Fla Koueta</name><affiliation><nlm:aff id="A15">Charles de Gaulle University Hospital, Ouagadougou, Burkina Faso</nlm:aff></affiliation></author><author><name sortKey="Chimbete, Cleophas" sort="Chimbete, Cleophas" uniqKey="Chimbete C" first="Cleophas" last="Chimbete">Cleophas Chimbete</name><affiliation><nlm:aff id="A16">Newlands Clinic, Harare, Zimbabwe</nlm:aff></affiliation></author><author><name sortKey="Lawson Evi, Annette" sort="Lawson Evi, Annette" uniqKey="Lawson Evi A" first="Annette" last="Lawson-Evi">Annette Lawson-Evi</name><affiliation><nlm:aff id="A17">Hospital du Tokoin, Lomé, Togo</nlm:aff></affiliation></author><author><name sortKey="Giddy, Janet" sort="Giddy, Janet" uniqKey="Giddy J" first="Janet" last="Giddy">Janet Giddy</name><affiliation><nlm:aff id="A18">Sinikithemba Clinic, McCord Hospital, Durban, South Africa</nlm:aff></affiliation></author><author><name sortKey="Amani Bosse, Clarisse" sort="Amani Bosse, Clarisse" uniqKey="Amani Bosse C" first="Clarisse" last="Amani-Bosse">Clarisse Amani-Bosse</name><affiliation><nlm:aff id="A19">MTCT-Plus Center, Abidjan, Côte d’Ivoire</nlm:aff></affiliation></author><author><name sortKey="Wood, Robin" sort="Wood, Robin" uniqKey="Wood R" first="Robin" last="Wood">Robin Wood</name><affiliation><nlm:aff id="A20">Desmond Tutu HIV Centre, Cape Town, South Africa</nlm:aff></affiliation><affiliation><nlm:aff id="A21">Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa</nlm:aff></affiliation></author><author><name sortKey="Egger, Matthias" sort="Egger, Matthias" uniqKey="Egger M" first="Matthias" last="Egger">Matthias Egger</name><affiliation><nlm:aff id="A22">Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland</nlm:aff></affiliation><affiliation><nlm:aff id="A1">Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa</nlm:aff></affiliation></author><author><name sortKey="Leroy, Valeriane" sort="Leroy, Valeriane" uniqKey="Leroy V" first="Valeriane" last="Leroy">Valeriane Leroy</name><affiliation><nlm:aff id="A2">University of Bordeaux, Institute of Epidemiology and Public Health, Bordeaux, France</nlm:aff></affiliation><affiliation><nlm:aff id="A23">Inserm, U897, Epidémiologie–Biostatistiques, Université Bordeaux, Bordeaux, France</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">26479876</idno><idno type="pmc">5410645</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5410645</idno><idno type="RBID">PMC:5410645</idno><idno type="doi">10.1097/EDE.0000000000000412</idno><date when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">000379</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000379</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Growth and Mortality Outcomes for Different Antiretroviral Therapy Initiation Criteria in Children aged 1–5 Years: A Causal Modelling Analysis</title><author><name sortKey="Schomaker, Michael" sort="Schomaker, Michael" uniqKey="Schomaker M" first="Michael" last="Schomaker">Michael Schomaker</name><affiliation><nlm:aff id="A1">Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa</nlm:aff></affiliation></author><author><name sortKey="Davies, Mary Ann" sort="Davies, Mary Ann" uniqKey="Davies M" first="Mary-Ann" last="Davies">Mary-Ann Davies</name><affiliation><nlm:aff id="A1">Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa</nlm:aff></affiliation></author><author><name sortKey="Malateste, Karen" sort="Malateste, Karen" uniqKey="Malateste K" first="Karen" last="Malateste">Karen Malateste</name><affiliation><nlm:aff id="A2">University of Bordeaux, Institute of Epidemiology and Public Health, Bordeaux, France</nlm:aff></affiliation></author><author><name sortKey="Renner, Lorna" sort="Renner, Lorna" uniqKey="Renner L" first="Lorna" last="Renner">Lorna Renner</name><affiliation><nlm:aff id="A3">University of Ghana Medical School, Accra, Ghana</nlm:aff></affiliation></author><author><name sortKey="Sawry, Shobna" sort="Sawry, Shobna" uniqKey="Sawry S" first="Shobna" last="Sawry">Shobna Sawry</name><affiliation><nlm:aff id="A4">University of the Witwatersrand, Wits Reproductive Health and HIV Institute, Harriet Shezi Children’s Clinic, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa</nlm:aff></affiliation></author><author><name sortKey="N Beche, Sylvie" sort="N Beche, Sylvie" uniqKey="N Beche S" first="Sylvie" last="N Beche">Sylvie N Beche</name><affiliation><nlm:aff id="A5">Centre de Prise en Charge de Recherche et de Formation Enfants, Abidjan, Côte d’Ivoire</nlm:aff></affiliation></author><author><name sortKey="Technau, Karl Gunter" sort="Technau, Karl Gunter" uniqKey="Technau K" first="Karl-Günter" last="Technau">Karl-Günter Technau</name><affiliation><nlm:aff id="A6">Empilweni Service and Research Unit, Rahima Moosa Mother and Child Hospital and University of the Witwatersrand, Johannesburg, South Africa</nlm:aff></affiliation></author><author><name sortKey="Eboua, Francois" sort="Eboua, Francois" uniqKey="Eboua F" first="François" last="Eboua">François Eboua</name><affiliation><nlm:aff id="A7">Yopougon University Hospital, Abidjan, Côte d’Ivoire</nlm:aff></affiliation></author><author><name sortKey="Tanser, Frank" sort="Tanser, Frank" uniqKey="Tanser F" first="Frank" last="Tanser">Frank Tanser</name><affiliation><nlm:aff id="A8">Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa</nlm:aff></affiliation></author><author><name sortKey="Sygnate Sy, Haby" sort="Sygnate Sy, Haby" uniqKey="Sygnate Sy H" first="Haby" last="Sygnaté-Sy">Haby Sygnaté-Sy</name><affiliation><nlm:aff id="A9">Albert Royer Hospital, Dakar, Senegal</nlm:aff></affiliation></author><author><name sortKey="Phiri, Sam" sort="Phiri, Sam" uniqKey="Phiri S" first="Sam" last="Phiri">Sam Phiri</name><affiliation><nlm:aff id="A10">Lighthouse Trust Clinic, Kamuzu Central Hospital, Lilongwe, Malawi</nlm:aff></affiliation><affiliation><nlm:aff id="A11">University of North Carolina, Chapel Hill, United States of America</nlm:aff></affiliation></author><author><name sortKey="Amorissani Folquet, Madeleine" sort="Amorissani Folquet, Madeleine" uniqKey="Amorissani Folquet M" first="Madeleine" last="Amorissani-Folquet">Madeleine Amorissani-Folquet</name><affiliation><nlm:aff id="A12">Félix Houphouët Boigny University Hospital, Abidjan, Côte d’Ivoire</nlm:aff></affiliation></author><author><name sortKey="Cox, Vivian" sort="Cox, Vivian" uniqKey="Cox V" first="Vivian" last="Cox">Vivian Cox</name><affiliation><nlm:aff id="A13">Médecins Sans Frontiéres South Africa, CapeTown, South Africa</nlm:aff></affiliation><affiliation><nlm:aff id="A14">Khayelitsha ART Programme, Khayelitsha, Cape Town, South Africa</nlm:aff></affiliation></author><author><name sortKey="Koueta, Fla" sort="Koueta, Fla" uniqKey="Koueta F" first="Fla" last="Koueta">Fla Koueta</name><affiliation><nlm:aff id="A15">Charles de Gaulle University Hospital, Ouagadougou, Burkina Faso</nlm:aff></affiliation></author><author><name sortKey="Chimbete, Cleophas" sort="Chimbete, Cleophas" uniqKey="Chimbete C" first="Cleophas" last="Chimbete">Cleophas Chimbete</name><affiliation><nlm:aff id="A16">Newlands Clinic, Harare, Zimbabwe</nlm:aff></affiliation></author><author><name sortKey="Lawson Evi, Annette" sort="Lawson Evi, Annette" uniqKey="Lawson Evi A" first="Annette" last="Lawson-Evi">Annette Lawson-Evi</name><affiliation><nlm:aff id="A17">Hospital du Tokoin, Lomé, Togo</nlm:aff></affiliation></author><author><name sortKey="Giddy, Janet" sort="Giddy, Janet" uniqKey="Giddy J" first="Janet" last="Giddy">Janet Giddy</name><affiliation><nlm:aff id="A18">Sinikithemba Clinic, McCord Hospital, Durban, South Africa</nlm:aff></affiliation></author><author><name sortKey="Amani Bosse, Clarisse" sort="Amani Bosse, Clarisse" uniqKey="Amani Bosse C" first="Clarisse" last="Amani-Bosse">Clarisse Amani-Bosse</name><affiliation><nlm:aff id="A19">MTCT-Plus Center, Abidjan, Côte d’Ivoire</nlm:aff></affiliation></author><author><name sortKey="Wood, Robin" sort="Wood, Robin" uniqKey="Wood R" first="Robin" last="Wood">Robin Wood</name><affiliation><nlm:aff id="A20">Desmond Tutu HIV Centre, Cape Town, South Africa</nlm:aff></affiliation><affiliation><nlm:aff id="A21">Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa</nlm:aff></affiliation></author><author><name sortKey="Egger, Matthias" sort="Egger, Matthias" uniqKey="Egger M" first="Matthias" last="Egger">Matthias Egger</name><affiliation><nlm:aff id="A22">Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland</nlm:aff></affiliation><affiliation><nlm:aff id="A1">Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa</nlm:aff></affiliation></author><author><name sortKey="Leroy, Valeriane" sort="Leroy, Valeriane" uniqKey="Leroy V" first="Valeriane" last="Leroy">Valeriane Leroy</name><affiliation><nlm:aff id="A2">University of Bordeaux, Institute of Epidemiology and Public Health, Bordeaux, France</nlm:aff></affiliation><affiliation><nlm:aff id="A23">Inserm, U897, Epidémiologie–Biostatistiques, Université Bordeaux, Bordeaux, France</nlm:aff></affiliation></author></analytic><series><title level="j">Epidemiology (Cambridge, Mass.)</title><idno type="ISSN">1044-3983</idno><idno type="eISSN">1531-5487</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="S1"><title>Background</title><p id="P1">There is limited evidence regarding the optimal timing of initiating antiretroviral therapy (ART) in children. We conducted a causal modelling analysis in children aged 1–5 years from the International Epidemiologic Databases to Evaluate AIDS West/Southern-Africa collaboration to determine growth and mortality differences related to different CD4-based treatment initiation criteria, age groups and regions.</p></sec><sec id="S2"><title>Methods</title><p id="P2">ART-naïve children of age 12–59 months at enrollment with at least one visit before ART initiation and one follow-up visit were included. We estimated 3-year growth and cumulative mortality from the start of follow-up for different CD4 criteria using g-computation.</p></sec><sec id="S3"><title>Results</title><p id="P3">About one quarter of the 5826 included children was from West Africa (24.6%). The median (first; third quartile) CD4% at the first visit was 16% (11%;23%), the median weight-for-age z-scores and height-for-age z-scores were −1.5 (−2.7; −0.6) and −2.5 (−3.5; −1.5), respectively. Estimated cumulative mortality was higher overall, and growth was slower, when initiating ART at lower CD4 thresholds. After 3 years of follow-up, the estimated mortality difference between starting ART routinely irrespective of CD4 count and starting ART if either CD4 count<750 cells/mm<sup>3</sup> or CD4%<25% was 0.2% (95%CI: −0.2%;0.3%), and the difference in the mean height-for-age z-scores of those who survived was −0.02 (95%CI: −0.04;0.01). Younger children aged 1–2 and children in West Africa had worse outcomes.</p></sec><sec id="S4"><title>Conclusions</title><p id="P4">Our results demonstrate that earlier treatment initiation yields overall better growth and mortality outcomes, though we could not show any differences in outcomes between immediate ART and delaying until CD4 count/% falls below750/25%.</p></sec></div></front></TEI><pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<pmc-dir>properties manuscript</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-journal-id">9009644</journal-id><journal-id journal-id-type="pubmed-jr-id">1090</journal-id><journal-id journal-id-type="nlm-ta">Epidemiology</journal-id><journal-id journal-id-type="iso-abbrev">Epidemiology</journal-id><journal-title-group><journal-title>Epidemiology (Cambridge, Mass.)</journal-title></journal-title-group><issn pub-type="ppub">1044-3983</issn><issn pub-type="epub">1531-5487</issn></journal-meta><article-meta><article-id pub-id-type="pmid">26479876</article-id><article-id pub-id-type="pmc">5410645</article-id><article-id pub-id-type="doi">10.1097/EDE.0000000000000412</article-id><article-id pub-id-type="manuscript">NIHMS857190</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Growth and Mortality Outcomes for Different Antiretroviral Therapy Initiation Criteria in Children aged 1–5 Years: A Causal Modelling Analysis</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Schomaker</surname><given-names>Michael</given-names></name><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Davies</surname><given-names>Mary-Ann</given-names></name><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Malateste</surname><given-names>Karen</given-names></name><xref ref-type="aff" rid="A2">2</xref></contrib><contrib contrib-type="author"><name><surname>Renner</surname><given-names>Lorna</given-names></name><xref ref-type="aff" rid="A3">3</xref></contrib><contrib contrib-type="author"><name><surname>Sawry</surname><given-names>Shobna</given-names></name><xref ref-type="aff" rid="A4">4</xref></contrib><contrib contrib-type="author"><name><surname>N’Gbeche</surname><given-names>Sylvie</given-names></name><xref ref-type="aff" rid="A5">5</xref></contrib><contrib contrib-type="author"><name><surname>Technau</surname><given-names>Karl-Günter</given-names></name><xref ref-type="aff" rid="A6">6</xref></contrib><contrib contrib-type="author"><name><surname>Eboua</surname><given-names>François</given-names></name><xref ref-type="aff" rid="A7">7</xref></contrib><contrib contrib-type="author"><name><surname>Tanser</surname><given-names>Frank</given-names></name><xref ref-type="aff" rid="A8">8</xref></contrib><contrib contrib-type="author"><name><surname>Sygnaté-Sy</surname><given-names>Haby</given-names></name><xref ref-type="aff" rid="A9">9</xref></contrib><contrib contrib-type="author"><name><surname>Phiri</surname><given-names>Sam</given-names></name><xref ref-type="aff" rid="A10">10</xref><xref ref-type="aff" rid="A11">11</xref></contrib><contrib contrib-type="author"><name><surname>Amorissani-Folquet</surname><given-names>Madeleine</given-names></name><xref ref-type="aff" rid="A12">12</xref></contrib><contrib contrib-type="author"><name><surname>Cox</surname><given-names>Vivian</given-names></name><xref ref-type="aff" rid="A13">13</xref><xref ref-type="aff" rid="A14">14</xref></contrib><contrib contrib-type="author"><name><surname>Koueta</surname><given-names>Fla</given-names></name><xref ref-type="aff" rid="A15">15</xref></contrib><contrib contrib-type="author"><name><surname>Chimbete</surname><given-names>Cleophas</given-names></name><xref ref-type="aff" rid="A16">16</xref></contrib><contrib contrib-type="author"><name><surname>Lawson-Evi</surname><given-names>Annette</given-names></name><xref ref-type="aff" rid="A17">17</xref></contrib><contrib contrib-type="author"><name><surname>Giddy</surname><given-names>Janet</given-names></name><xref ref-type="aff" rid="A18">18</xref></contrib><contrib contrib-type="author"><name><surname>Amani-Bosse</surname><given-names>Clarisse</given-names></name><xref ref-type="aff" rid="A19">19</xref></contrib><contrib contrib-type="author"><name><surname>Wood</surname><given-names>Robin</given-names></name><xref ref-type="aff" rid="A20">20</xref><xref ref-type="aff" rid="A21">21</xref></contrib><contrib contrib-type="author"><name><surname>Egger</surname><given-names>Matthias</given-names></name><xref ref-type="aff" rid="A22">22</xref><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Leroy</surname><given-names>Valeriane</given-names></name><xref ref-type="aff" rid="A2">2</xref><xref ref-type="aff" rid="A23">23</xref></contrib></contrib-group><aff id="A1"><label>1</label>Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa</aff><aff id="A2"><label>2</label>University of Bordeaux, Institute of Epidemiology and Public Health, Bordeaux, France</aff><aff id="A3"><label>3</label>University of Ghana Medical School, Accra, Ghana</aff><aff id="A4"><label>4</label>University of the Witwatersrand, Wits Reproductive Health and HIV Institute, Harriet Shezi Children’s Clinic, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa</aff><aff id="A5"><label>5</label>Centre de Prise en Charge de Recherche et de Formation Enfants, Abidjan, Côte d’Ivoire</aff><aff id="A6"><label>6</label>Empilweni Service and Research Unit, Rahima Moosa Mother and Child Hospital and University of the Witwatersrand, Johannesburg, South Africa</aff><aff id="A7"><label>7</label>Yopougon University Hospital, Abidjan, Côte d’Ivoire</aff><aff id="A8"><label>8</label>Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa</aff><aff id="A9"><label>9</label>Albert Royer Hospital, Dakar, Senegal</aff><aff id="A10"><label>10</label>Lighthouse Trust Clinic, Kamuzu Central Hospital, Lilongwe, Malawi</aff><aff id="A11"><label>11</label>University of North Carolina, Chapel Hill, United States of America</aff><aff id="A12"><label>12</label>Félix Houphouët Boigny University Hospital, Abidjan, Côte d’Ivoire</aff><aff id="A13"><label>13</label>Médecins Sans Frontiéres South Africa, CapeTown, South Africa</aff><aff id="A14"><label>14</label>Khayelitsha ART Programme, Khayelitsha, Cape Town, South Africa</aff><aff id="A15"><label>15</label>Charles de Gaulle University Hospital, Ouagadougou, Burkina Faso</aff><aff id="A16"><label>16</label>Newlands Clinic, Harare, Zimbabwe</aff><aff id="A17"><label>17</label>Hospital du Tokoin, Lomé, Togo</aff><aff id="A18"><label>18</label>Sinikithemba Clinic, McCord Hospital, Durban, South Africa</aff><aff id="A19"><label>19</label>MTCT-Plus Center, Abidjan, Côte d’Ivoire</aff><aff id="A20"><label>20</label>Desmond Tutu HIV Centre, Cape Town, South Africa</aff><aff id="A21"><label>21</label>Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa</aff><aff id="A22"><label>22</label>Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland</aff><aff id="A23"><label>23</label>Inserm, U897, Epidémiologie–Biostatistiques, Université Bordeaux, Bordeaux, France</aff><author-notes><corresp id="FN1"><bold>Corresponding author:</bold> Michael Schomaker, University of Cape Town, Centre for Infectious Disease Epidemiology and Research, Falmouth Building, Anzio Road, Observatory 7925, Cape Town, South Africa; <email>Michael.schomaker@uct.ac.za</email>, Tel: +27 21 4047737</corresp></author-notes><pub-date pub-type="nihms-submitted"><day>18</day><month>3</month><year>2017</year></pub-date><pub-date pub-type="ppub"><month>3</month><year>2016</year></pub-date><pub-date pub-type="pmc-release"><day>01</day><month>5</month><year>2017</year></pub-date><volume>27</volume><issue>2</issue><fpage>237</fpage><lpage>246</lpage><pmc-comment>elocation-id from pubmed: 10.1097/EDE.0000000000000412</pmc-comment>
<abstract><sec id="S1"><title>Background</title><p id="P1">There is limited evidence regarding the optimal timing of initiating antiretroviral therapy (ART) in children. We conducted a causal modelling analysis in children aged 1–5 years from the International Epidemiologic Databases to Evaluate AIDS West/Southern-Africa collaboration to determine growth and mortality differences related to different CD4-based treatment initiation criteria, age groups and regions.</p></sec><sec id="S2"><title>Methods</title><p id="P2">ART-naïve children of age 12–59 months at enrollment with at least one visit before ART initiation and one follow-up visit were included. We estimated 3-year growth and cumulative mortality from the start of follow-up for different CD4 criteria using g-computation.</p></sec><sec id="S3"><title>Results</title><p id="P3">About one quarter of the 5826 included children was from West Africa (24.6%). The median (first; third quartile) CD4% at the first visit was 16% (11%;23%), the median weight-for-age z-scores and height-for-age z-scores were −1.5 (−2.7; −0.6) and −2.5 (−3.5; −1.5), respectively. Estimated cumulative mortality was higher overall, and growth was slower, when initiating ART at lower CD4 thresholds. After 3 years of follow-up, the estimated mortality difference between starting ART routinely irrespective of CD4 count and starting ART if either CD4 count<750 cells/mm<sup>3</sup> or CD4%<25% was 0.2% (95%CI: −0.2%;0.3%), and the difference in the mean height-for-age z-scores of those who survived was −0.02 (95%CI: −0.04;0.01). Younger children aged 1–2 and children in West Africa had worse outcomes.</p></sec><sec id="S4"><title>Conclusions</title><p id="P4">Our results demonstrate that earlier treatment initiation yields overall better growth and mortality outcomes, though we could not show any differences in outcomes between immediate ART and delaying until CD4 count/% falls below750/25%.</p></sec></abstract></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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