SidaSubSaharaV1, Main, Exploration, bibRecord, 002070

Prognosis of Children With HIV-1 Infection Starting Antiretroviral Therapy in Southern Africa: A Collaborative Analysis of Treatment Programs

Identifieur interne : 002070 ( Main/Exploration ); précédent : 002069; suivant : 002071

Prognosis of Children With HIV-1 Infection Starting Antiretroviral Therapy in Southern Africa: A Collaborative Analysis of Treatment Programs

Source :

The Pediatric infectious disease journal [ 0891-3668 ] ; 2014.

RBID : Pascal:14-0190525

Descripteurs français

Pascal (Inist)
- SIDA, Antiviral, Chimiothérapie, Pronostic, Antirétroviral, Enfant, Virus HIV1, Afrique australe, Mortalité, Afrique subsaharienne, Pédiatrie.
Wicri :
- topic : Enfant, Mortalité, Pédiatrie.

English descriptors

KwdEn :
- AIDS, Antiretroviral agent, Antiviral, Chemotherapy, Child, HIV-1 virus, Mortality, Pediatrics, Prognosis, Southern Africa, Sub-Saharan Africa.

Abstract

Background: Prognostic models for children starting antiretroviral therapy (ART) in Africa are lacking. We developed models to estimate the probability of death during the first year receiving ART in Southern Africa. Methods: We analyzed data from children ≤10 years of age who started ART in Malawi, South Africa, Zambia or Zimbabwe from 2004 to 2010. Children lost to follow up or transferred were excluded. The primary outcome was all-cause mortality in the first year of ART. We used Weibull survival models to construct 2 prognostic models: 1 with CD4%, age, World Health Organization clinical stage, weight-for-age z-score (WAZ) and anemia and the other without CD4%, because it is not routinely measured in many programs. We used multiple imputation to account for missing data. Results: Among 12,655 children, 877 (6.9%) died in the first year of ART. We excluded 1780 children who were lost to follow up/transferred from main analyses; 10,875 children were therefore included. With the CD4% model probability of death at 1 year ranged from 1.8% [95% confidence interval (CI): 1.5-2.3] in children 5-10 years with CD4% ≥10%, World Health Organization stage I/II, WAZ ≥-2 and without severe anemia to 46.3% (95% CI: 38.2-55.2) in children <1 year with CD4% <5%, stage III/ IV, WAZ< -3 and severe anemia. The corresponding range for the model without CD4% was 2.2% (95% CI: 1.8-2.7) to 33.4% (95% CI: 28.2-39.3). Agreement between predicted and observed mortality was good (C-statistics = 0.753 and 0.745 for models with and without CD4%, respectively). Conclusions: These models may be useful to counsel children/caregivers, for program planning and to assess program outcomes after allowing for differences in patient disease severity characteristics.

Affiliations:

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Le document en format XML

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<author><name sortKey="Chimbetete, Cleophas" sort="Chimbetete, Cleophas" uniqKey="Chimbetete C" first="Cleophas" last="Chimbetete">Cleophas Chimbetete</name>
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<author><name sortKey="Eley, Brian" sort="Eley, Brian" uniqKey="Eley B" first="Brian" last="Eley">Brian Eley</name>
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<author><name sortKey="Garone, Daniela" sort="Garone, Daniela" uniqKey="Garone D" first="Daniela" last="Garone">Daniela Garone</name>
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<author><name sortKey="Moultrie, Harry" sort="Moultrie, Harry" uniqKey="Moultrie H" first="Harry" last="Moultrie">Harry Moultrie</name>
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<author><name sortKey="Ndirangu, James" sort="Ndirangu, James" uniqKey="Ndirangu J" first="James" last="Ndirangu">James Ndirangu</name>
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<author><name sortKey="Phiri, Sam" sort="Phiri, Sam" uniqKey="Phiri S" first="Sam" last="Phiri">Sam Phiri</name>
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<author><name sortKey="Wood, Robin" sort="Wood, Robin" uniqKey="Wood R" first="Robin" last="Wood">Robin Wood</name>
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<author><name sortKey="Boulle, Andrew" sort="Boulle, Andrew" uniqKey="Boulle A" first="Andrew" last="Boulle">Andrew Boulle</name>
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<wicri:noRegion>Cape Town</wicri:noRegion>
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<author><name sortKey="Egger, Matthias" sort="Egger, Matthias" uniqKey="Egger M" first="Matthias" last="Egger">Matthias Egger</name>
<affiliation wicri:level="1"><inist:fA14 i1="01"><s1>School of Public Health and Family Medicine, University of Cape Town</s1>
<s2>Cape Town</s2>
<s3>ZAF</s3>
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<country>Afrique du Sud</country>
<wicri:noRegion>Cape Town</wicri:noRegion>
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<affiliation wicri:level="4"><inist:fA14 i1="16"><s1>Institute of Social and Preventive Medicine (ISPM), University of Bern</s1>
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<country>Suisse</country>
<placeName><settlement type="city">Berne</settlement>
<region nuts="3" type="region">Canton de Berne</region>
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<orgName type="university">Université de Berne</orgName>
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<author><name sortKey="Keiser, Olivia" sort="Keiser, Olivia" uniqKey="Keiser O" first="Olivia" last="Keiser">Olivia Keiser</name>
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Prognosis of Children With HIV-1 Infection Starting Antiretroviral Therapy in Southern Africa: A Collaborative Analysis of Treatment Programs</title>
<author><name sortKey="Davies, Mary Ann" sort="Davies, Mary Ann" uniqKey="Davies M" first="Mary-Ann" last="Davies">Mary-Ann Davies</name>
<affiliation wicri:level="1"><inist:fA14 i1="01"><s1>School of Public Health and Family Medicine, University of Cape Town</s1>
<s2>Cape Town</s2>
<s3>ZAF</s3>
<sZ>1 aut.</sZ>
<sZ>14 aut.</sZ>
<sZ>15 aut.</sZ>
</inist:fA14>
<country>Afrique du Sud</country>
<wicri:noRegion>Cape Town</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="May, Margaret" sort="May, Margaret" uniqKey="May M" first="Margaret" last="May">Margaret May</name>
<affiliation wicri:level="1"><inist:fA14 i1="02"><s1>School of Social and Community Medicine, University of Bristol</s1>
<s2>Bristol</s2>
<s3>GBR</s3>
<sZ>2 aut.</sZ>
</inist:fA14>
<country>Royaume-Uni</country>
<wicri:noRegion>Bristol</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Bolton Moore, Carolyn" sort="Bolton Moore, Carolyn" uniqKey="Bolton Moore C" first="Carolyn" last="Bolton-Moore">Carolyn Bolton-Moore</name>
<affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Centre for Infectious Disease Research in Zambia</s1>
<s2>Lusaka</s2>
<s3>ZMB</s3>
<sZ>3 aut.</sZ>
</inist:fA14>
<country>Zambie</country>
<wicri:noRegion>Centre for Infectious Disease Research in Zambia</wicri:noRegion>
</affiliation>
<affiliation wicri:level="2"><inist:fA14 i1="04"><s1>University of North Carolina</s1>
<s2>Chapel Hill, NC</s2>
<s3>USA</s3>
<sZ>3 aut.</sZ>
</inist:fA14>
<country>États-Unis</country>
<placeName><region type="state">Caroline du Nord</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Chimbetete, Cleophas" sort="Chimbetete, Cleophas" uniqKey="Chimbetete C" first="Cleophas" last="Chimbetete">Cleophas Chimbetete</name>
<affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Newlands clinic</s1>
<s2>Harare</s2>
<s3>ZWE</s3>
<sZ>4 aut.</sZ>
</inist:fA14>
<country>Zimbabwe</country>
<wicri:noRegion>Newlands clinic</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Eley, Brian" sort="Eley, Brian" uniqKey="Eley B" first="Brian" last="Eley">Brian Eley</name>
<affiliation wicri:level="1"><inist:fA14 i1="06"><s1>Red Cross Children's Hospital and School of Child and Adolescent Health, University of Cape Town</s1>
<s3>ZAF</s3>
<sZ>5 aut.</sZ>
</inist:fA14>
<country>Afrique du Sud</country>
<wicri:noRegion>Red Cross Children's Hospital and School of Child and Adolescent Health, University of Cape Town</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Garone, Daniela" sort="Garone, Daniela" uniqKey="Garone D" first="Daniela" last="Garone">Daniela Garone</name>
<affiliation wicri:level="1"><inist:fA14 i1="07"><s1>Médecins Sans Frontières (MSF) South Africa and Khayelitsha ART Programme</s1>
<s2>Cape Town</s2>
<s3>ZAF</s3>
<sZ>6 aut.</sZ>
</inist:fA14>
<country>Afrique du Sud</country>
<wicri:noRegion>Médecins Sans Frontières (MSF) South Africa and Khayelitsha ART Programme</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Giddy, Janet" sort="Giddy, Janet" uniqKey="Giddy J" first="Janet" last="Giddy">Janet Giddy</name>
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<s2>Durban</s2>
<s3>ZAF</s3>
<sZ>7 aut.</sZ>
</inist:fA14>
<country>Afrique du Sud</country>
<wicri:noRegion>Durban</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Moultrie, Harry" sort="Moultrie, Harry" uniqKey="Moultrie H" first="Harry" last="Moultrie">Harry Moultrie</name>
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<s2>Johannesburg</s2>
<s3>ZAF</s3>
<sZ>8 aut.</sZ>
</inist:fA14>
<country>Afrique du Sud</country>
<placeName><settlement type="city">Johannesbourg</settlement>
<region type="region" nuts="2">Gauteng</region>
</placeName>
<orgName type="university">Université du Witwatersrand</orgName>
</affiliation>
<affiliation wicri:level="1"><inist:fA14 i1="10"><s1>Harriet Shezi Children's Clinic, Chris Hani Baragwanath Hospital</s1>
<s2>Soweto</s2>
<s3>ZAF</s3>
<sZ>8 aut.</sZ>
</inist:fA14>
<country>Afrique du Sud</country>
<wicri:noRegion>Soweto</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Ndirangu, James" sort="Ndirangu, James" uniqKey="Ndirangu J" first="James" last="Ndirangu">James Ndirangu</name>
<affiliation wicri:level="1"><inist:fA14 i1="11"><s1>Africa Centre for Health and Population Studies, University of Kwazulu-Natal</s1>
<s2>Somkhele</s2>
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<country>Afrique du Sud</country>
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<author><name sortKey="Phiri, Sam" sort="Phiri, Sam" uniqKey="Phiri S" first="Sam" last="Phiri">Sam Phiri</name>
<affiliation wicri:level="1"><inist:fA14 i1="12"><s1>Lighthouse Trust Clinic, Kamuzu Central Hospital, Lilongwe, Malawi and Liverpool School of Tropical Medicine</s1>
<s2>Liverpool</s2>
<s3>GBR</s3>
<sZ>10 aut.</sZ>
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<country>Royaume-Uni</country>
<wicri:noRegion>Liverpool</wicri:noRegion>
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<author><name sortKey="Rabie, Helena" sort="Rabie, Helena" uniqKey="Rabie H" first="Helena" last="Rabie">Helena Rabie</name>
<affiliation wicri:level="1"><inist:fA14 i1="13"><s1>Tygerberg Academic Hospital, University of Stellenbosch</s1>
<s2>Stellenbosch</s2>
<s3>ZAF</s3>
<sZ>11 aut.</sZ>
</inist:fA14>
<country>Afrique du Sud</country>
<wicri:noRegion>Stellenbosch</wicri:noRegion>
</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 wicri:level="4"><inist:fA14 i1="14"><s1>Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, and University of the Witwatersrand</s1>
<s2>Johannesburg</s2>
<s3>ZAF</s3>
<sZ>12 aut.</sZ>
</inist:fA14>
<country>Afrique du Sud</country>
<placeName><settlement type="city">Johannesbourg</settlement>
<region type="region" nuts="2">Gauteng</region>
</placeName>
<orgName type="university">Université du Witwatersrand</orgName>
</affiliation>
</author>
<author><name sortKey="Wood, Robin" sort="Wood, Robin" uniqKey="Wood R" first="Robin" last="Wood">Robin Wood</name>
<affiliation wicri:level="1"><inist:fA14 i1="15"><s1>Gugulethu ART Programme and Desmond Tutu HIV Centre, University of Cape Town</s1>
<s2>Cape Town</s2>
<s3>ZAF</s3>
<sZ>13 aut.</sZ>
</inist:fA14>
<country>Afrique du Sud</country>
<wicri:noRegion>Cape Town</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Boulle, Andrew" sort="Boulle, Andrew" uniqKey="Boulle A" first="Andrew" last="Boulle">Andrew Boulle</name>
<affiliation wicri:level="1"><inist:fA14 i1="01"><s1>School of Public Health and Family Medicine, University of Cape Town</s1>
<s2>Cape Town</s2>
<s3>ZAF</s3>
<sZ>1 aut.</sZ>
<sZ>14 aut.</sZ>
<sZ>15 aut.</sZ>
</inist:fA14>
<country>Afrique du Sud</country>
<wicri:noRegion>Cape Town</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Egger, Matthias" sort="Egger, Matthias" uniqKey="Egger M" first="Matthias" last="Egger">Matthias Egger</name>
<affiliation wicri:level="1"><inist:fA14 i1="01"><s1>School of Public Health and Family Medicine, University of Cape Town</s1>
<s2>Cape Town</s2>
<s3>ZAF</s3>
<sZ>1 aut.</sZ>
<sZ>14 aut.</sZ>
<sZ>15 aut.</sZ>
</inist:fA14>
<country>Afrique du Sud</country>
<wicri:noRegion>Cape Town</wicri:noRegion>
</affiliation>
<affiliation wicri:level="4"><inist:fA14 i1="16"><s1>Institute of Social and Preventive Medicine (ISPM), University of Bern</s1>
<s3>CHE</s3>
<sZ>15 aut.</sZ>
<sZ>16 aut.</sZ>
</inist:fA14>
<country>Suisse</country>
<placeName><settlement type="city">Berne</settlement>
<region nuts="3" type="region">Canton de Berne</region>
</placeName>
<orgName type="university">Université de Berne</orgName>
</affiliation>
</author>
<author><name sortKey="Keiser, Olivia" sort="Keiser, Olivia" uniqKey="Keiser O" first="Olivia" last="Keiser">Olivia Keiser</name>
<affiliation wicri:level="4"><inist:fA14 i1="16"><s1>Institute of Social and Preventive Medicine (ISPM), University of Bern</s1>
<s3>CHE</s3>
<sZ>15 aut.</sZ>
<sZ>16 aut.</sZ>
</inist:fA14>
<country>Suisse</country>
<placeName><settlement type="city">Berne</settlement>
<region nuts="3" type="region">Canton de Berne</region>
</placeName>
<orgName type="university">Université de Berne</orgName>
</affiliation>
</author>
</analytic>
<series><title level="j" type="main">The Pediatric infectious disease journal</title>
<title level="j" type="abbreviated">Pediatr. infect. dis. j.</title>
<idno type="ISSN">0891-3668</idno>
<imprint><date when="2014">2014</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
<seriesStmt><title level="j" type="main">The Pediatric infectious disease journal</title>
<title level="j" type="abbreviated">Pediatr. infect. dis. j.</title>
<idno type="ISSN">0891-3668</idno>
</seriesStmt>
</fileDesc>
<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>AIDS</term>
<term>Antiretroviral agent</term>
<term>Antiviral</term>
<term>Chemotherapy</term>
<term>Child</term>
<term>HIV-1 virus</term>
<term>Mortality</term>
<term>Pediatrics</term>
<term>Prognosis</term>
<term>Southern Africa</term>
<term>Sub-Saharan Africa</term>
</keywords>
<keywords scheme="Pascal" xml:lang="fr"><term>SIDA</term>
<term>Antiviral</term>
<term>Chimiothérapie</term>
<term>Pronostic</term>
<term>Antirétroviral</term>
<term>Enfant</term>
<term>Virus HIV1</term>
<term>Afrique australe</term>
<term>Mortalité</term>
<term>Afrique subsaharienne</term>
<term>Pédiatrie</term>
</keywords>
<keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Enfant</term>
<term>Mortalité</term>
<term>Pédiatrie</term>
</keywords>
</textClass>
</profileDesc>
</teiHeader>
<front><div type="abstract" xml:lang="en">Background: Prognostic models for children starting antiretroviral therapy (ART) in Africa are lacking. We developed models to estimate the probability of death during the first year receiving ART in Southern Africa. Methods: We analyzed data from children ≤10 years of age who started ART in Malawi, South Africa, Zambia or Zimbabwe from 2004 to 2010. Children lost to follow up or transferred were excluded. The primary outcome was all-cause mortality in the first year of ART. We used Weibull survival models to construct 2 prognostic models: 1 with CD4%, age, World Health Organization clinical stage, weight-for-age z-score (WAZ) and anemia and the other without CD4%, because it is not routinely measured in many programs. We used multiple imputation to account for missing data. Results: Among 12,655 children, 877 (6.9%) died in the first year of ART. We excluded 1780 children who were lost to follow up/transferred from main analyses; 10,875 children were therefore included. With the CD4% model probability of death at 1 year ranged from 1.8% [95% confidence interval (CI): 1.5-2.3] in children 5-10 years with CD4% ≥10%, World Health Organization stage I/II, WAZ ≥-2 and without severe anemia to 46.3% (95% CI: 38.2-55.2) in children <1 year with CD4% <5%, stage III/ IV, WAZ< -3 and severe anemia. The corresponding range for the model without CD4% was 2.2% (95% CI: 1.8-2.7) to 33.4% (95% CI: 28.2-39.3). Agreement between predicted and observed mortality was good (C-statistics = 0.753 and 0.745 for models with and without CD4%, respectively). Conclusions: These models may be useful to counsel children/caregivers, for program planning and to assess program outcomes after allowing for differences in patient disease severity characteristics.</div>
</front>
</TEI>
<affiliations><list><country><li>Afrique du Sud</li>
<li>Royaume-Uni</li>
<li>Suisse</li>
<li>Zambie</li>
<li>Zimbabwe</li>
<li>États-Unis</li>
</country>
<region><li>Canton de Berne</li>
<li>Caroline du Nord</li>
<li>Gauteng</li>
</region>
<settlement><li>Berne</li>
<li>Johannesbourg</li>
</settlement>
<orgName><li>Université de Berne</li>
<li>Université du Witwatersrand</li>
</orgName>
</list>
<tree><country name="Afrique du Sud"><noRegion><name sortKey="Davies, Mary Ann" sort="Davies, Mary Ann" uniqKey="Davies M" first="Mary-Ann" last="Davies">Mary-Ann Davies</name>
</noRegion>
<name sortKey="Boulle, Andrew" sort="Boulle, Andrew" uniqKey="Boulle A" first="Andrew" last="Boulle">Andrew Boulle</name>
<name sortKey="Egger, Matthias" sort="Egger, Matthias" uniqKey="Egger M" first="Matthias" last="Egger">Matthias Egger</name>
<name sortKey="Eley, Brian" sort="Eley, Brian" uniqKey="Eley B" first="Brian" last="Eley">Brian Eley</name>
<name sortKey="Garone, Daniela" sort="Garone, Daniela" uniqKey="Garone D" first="Daniela" last="Garone">Daniela Garone</name>
<name sortKey="Giddy, Janet" sort="Giddy, Janet" uniqKey="Giddy J" first="Janet" last="Giddy">Janet Giddy</name>
<name sortKey="Moultrie, Harry" sort="Moultrie, Harry" uniqKey="Moultrie H" first="Harry" last="Moultrie">Harry Moultrie</name>
<name sortKey="Moultrie, Harry" sort="Moultrie, Harry" uniqKey="Moultrie H" first="Harry" last="Moultrie">Harry Moultrie</name>
<name sortKey="Ndirangu, James" sort="Ndirangu, James" uniqKey="Ndirangu J" first="James" last="Ndirangu">James Ndirangu</name>
<name sortKey="Rabie, Helena" sort="Rabie, Helena" uniqKey="Rabie H" first="Helena" last="Rabie">Helena Rabie</name>
<name sortKey="Technau, Karl Gunter" sort="Technau, Karl Gunter" uniqKey="Technau K" first="Karl-Günter" last="Technau">Karl-Günter Technau</name>
<name sortKey="Wood, Robin" sort="Wood, Robin" uniqKey="Wood R" first="Robin" last="Wood">Robin Wood</name>
</country>
<country name="Royaume-Uni"><noRegion><name sortKey="May, Margaret" sort="May, Margaret" uniqKey="May M" first="Margaret" last="May">Margaret May</name>
</noRegion>
<name sortKey="Phiri, Sam" sort="Phiri, Sam" uniqKey="Phiri S" first="Sam" last="Phiri">Sam Phiri</name>
</country>
<country name="Zambie"><noRegion><name sortKey="Bolton Moore, Carolyn" sort="Bolton Moore, Carolyn" uniqKey="Bolton Moore C" first="Carolyn" last="Bolton-Moore">Carolyn Bolton-Moore</name>
</noRegion>
</country>
<country name="États-Unis"><region name="Caroline du Nord"><name sortKey="Bolton Moore, Carolyn" sort="Bolton Moore, Carolyn" uniqKey="Bolton Moore C" first="Carolyn" last="Bolton-Moore">Carolyn Bolton-Moore</name>
</region>
</country>
<country name="Zimbabwe"><noRegion><name sortKey="Chimbetete, Cleophas" sort="Chimbetete, Cleophas" uniqKey="Chimbetete C" first="Cleophas" last="Chimbetete">Cleophas Chimbetete</name>
</noRegion>
</country>
<country name="Suisse"><region name="Canton de Berne"><name sortKey="Egger, Matthias" sort="Egger, Matthias" uniqKey="Egger M" first="Matthias" last="Egger">Matthias Egger</name>
</region>
<name sortKey="Keiser, Olivia" sort="Keiser, Olivia" uniqKey="Keiser O" first="Olivia" last="Keiser">Olivia Keiser</name>
</country>
</tree>
</affiliations>
</record>

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	Le SIDA en Afrique subsaharienne (serveur d'exploration)
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Le SIDA en Afrique subsaharienne (serveur d'exploration)

Prognosis of Children With HIV-1 Infection Starting Antiretroviral Therapy in Southern Africa: A Collaborative Analysis of Treatment Programs

Prognosis of Children With HIV-1 Infection Starting Antiretroviral Therapy in Southern Africa: A Collaborative Analysis of Treatment Programs

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