Quantification of CD4 responses to combined antiretroviral therapy over 5 years among HIV-infected children in Kinshasa, Democratic Republic of Congo

Andrew Edmonds, Marcel Yotebieng, Jean Lusiama, Yori Matumona, Faustin Kitetele, David Nku, Sonia Napravnik, Stephen R. Cole, Annelies Van Rie, Frieda Behets

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background: The long-term effects of combined antiretroviral therapy (cART) on CD4 percentage in HIV-infected children are incompletely understood, with evidence from resource-deprived areas particularly scarce even though most children with HIV live in such settings. We sought to describe this relationship. Methods: Observational longitudinal data from cART-naive children enrolled between December 2004 and May 2010 into an HIV care and treatment program in Kinshasa, Democratic Republic of Congo were analyzed. To estimate the effect of cART on CD4 percentage while accounting for time-dependent confounders affected by prior exposure to cART, a marginal structural linear mean model was used. Results: Seven hundred ninety children were active for 2090 person-years and a median of 31 months; 619 (78%) initiated cART. At baseline, 405 children (51%) were in HIV clinical stage 3 or 4; 528 (67%) had advanced or severe immunodeficiency. Compared with no cART, the estimated absolute rise in CD4 percentage was 6.8% [95% confidence interval (CI), 4.7% to 8.9%] after 6 months of cART, 8.6% (95% CI, 7.0% to 10.2%) after 12 months, and 20.5% (95% CI, 16.1% to 24.9%) after 60 months. cART-mediated CD4 percentage gains were slowest but greatest among children with baseline CD4 percentage <15. The cumulative incidence of recovery to "not significant" World Health Organization age-specific immunodeficiency was lower if cART was started when immunodeficiency was severe rather than mild or advanced. Conclusions: cART increased CD4 percentages among HIV-infected children in a resource-deprived setting, as previously noted among children in the United States. More gradual and protracted recovery in children with lower baseline CD4 percentages supports earlier initiation of pediatric cART.

Original languageEnglish (US)
Pages (from-to)90-98
Number of pages9
JournalJournal of Acquired Immune Deficiency Syndromes
Volume61
Issue number1
DOIs
StatePublished - Sep 1 2012
Externally publishedYes

Fingerprint

Democratic Republic of the Congo
HIV
Therapeutics
Confidence Intervals
Linear Models

Keywords

  • antiretroviral therapy
  • CD4
  • Democratic Republic of the Congo
  • HIV
  • models
  • paediatrics
  • statistical

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

Cite this

Quantification of CD4 responses to combined antiretroviral therapy over 5 years among HIV-infected children in Kinshasa, Democratic Republic of Congo. / Edmonds, Andrew; Yotebieng, Marcel; Lusiama, Jean; Matumona, Yori; Kitetele, Faustin; Nku, David; Napravnik, Sonia; Cole, Stephen R.; Van Rie, Annelies; Behets, Frieda.

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 61, No. 1, 01.09.2012, p. 90-98.

Research output: Contribution to journalArticle

Edmonds, Andrew ; Yotebieng, Marcel ; Lusiama, Jean ; Matumona, Yori ; Kitetele, Faustin ; Nku, David ; Napravnik, Sonia ; Cole, Stephen R. ; Van Rie, Annelies ; Behets, Frieda. / Quantification of CD4 responses to combined antiretroviral therapy over 5 years among HIV-infected children in Kinshasa, Democratic Republic of Congo. In: Journal of Acquired Immune Deficiency Syndromes. 2012 ; Vol. 61, No. 1. pp. 90-98.
@article{c9cd394545a0416a89a6a2e229220758,
title = "Quantification of CD4 responses to combined antiretroviral therapy over 5 years among HIV-infected children in Kinshasa, Democratic Republic of Congo",
abstract = "Background: The long-term effects of combined antiretroviral therapy (cART) on CD4 percentage in HIV-infected children are incompletely understood, with evidence from resource-deprived areas particularly scarce even though most children with HIV live in such settings. We sought to describe this relationship. Methods: Observational longitudinal data from cART-naive children enrolled between December 2004 and May 2010 into an HIV care and treatment program in Kinshasa, Democratic Republic of Congo were analyzed. To estimate the effect of cART on CD4 percentage while accounting for time-dependent confounders affected by prior exposure to cART, a marginal structural linear mean model was used. Results: Seven hundred ninety children were active for 2090 person-years and a median of 31 months; 619 (78{\%}) initiated cART. At baseline, 405 children (51{\%}) were in HIV clinical stage 3 or 4; 528 (67{\%}) had advanced or severe immunodeficiency. Compared with no cART, the estimated absolute rise in CD4 percentage was 6.8{\%} [95{\%} confidence interval (CI), 4.7{\%} to 8.9{\%}] after 6 months of cART, 8.6{\%} (95{\%} CI, 7.0{\%} to 10.2{\%}) after 12 months, and 20.5{\%} (95{\%} CI, 16.1{\%} to 24.9{\%}) after 60 months. cART-mediated CD4 percentage gains were slowest but greatest among children with baseline CD4 percentage <15. The cumulative incidence of recovery to {"}not significant{"} World Health Organization age-specific immunodeficiency was lower if cART was started when immunodeficiency was severe rather than mild or advanced. Conclusions: cART increased CD4 percentages among HIV-infected children in a resource-deprived setting, as previously noted among children in the United States. More gradual and protracted recovery in children with lower baseline CD4 percentages supports earlier initiation of pediatric cART.",
keywords = "antiretroviral therapy, CD4, Democratic Republic of the Congo, HIV, models, paediatrics, statistical",
author = "Andrew Edmonds and Marcel Yotebieng and Jean Lusiama and Yori Matumona and Faustin Kitetele and David Nku and Sonia Napravnik and Cole, {Stephen R.} and {Van Rie}, Annelies and Frieda Behets",
year = "2012",
month = "9",
day = "1",
doi = "10.1097/QAI.0b013e31825bd9b7",
language = "English (US)",
volume = "61",
pages = "90--98",
journal = "Journal of Acquired Immune Deficiency Syndromes",
issn = "1525-4135",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - Quantification of CD4 responses to combined antiretroviral therapy over 5 years among HIV-infected children in Kinshasa, Democratic Republic of Congo

AU - Edmonds, Andrew

AU - Yotebieng, Marcel

AU - Lusiama, Jean

AU - Matumona, Yori

AU - Kitetele, Faustin

AU - Nku, David

AU - Napravnik, Sonia

AU - Cole, Stephen R.

AU - Van Rie, Annelies

AU - Behets, Frieda

PY - 2012/9/1

Y1 - 2012/9/1

N2 - Background: The long-term effects of combined antiretroviral therapy (cART) on CD4 percentage in HIV-infected children are incompletely understood, with evidence from resource-deprived areas particularly scarce even though most children with HIV live in such settings. We sought to describe this relationship. Methods: Observational longitudinal data from cART-naive children enrolled between December 2004 and May 2010 into an HIV care and treatment program in Kinshasa, Democratic Republic of Congo were analyzed. To estimate the effect of cART on CD4 percentage while accounting for time-dependent confounders affected by prior exposure to cART, a marginal structural linear mean model was used. Results: Seven hundred ninety children were active for 2090 person-years and a median of 31 months; 619 (78%) initiated cART. At baseline, 405 children (51%) were in HIV clinical stage 3 or 4; 528 (67%) had advanced or severe immunodeficiency. Compared with no cART, the estimated absolute rise in CD4 percentage was 6.8% [95% confidence interval (CI), 4.7% to 8.9%] after 6 months of cART, 8.6% (95% CI, 7.0% to 10.2%) after 12 months, and 20.5% (95% CI, 16.1% to 24.9%) after 60 months. cART-mediated CD4 percentage gains were slowest but greatest among children with baseline CD4 percentage <15. The cumulative incidence of recovery to "not significant" World Health Organization age-specific immunodeficiency was lower if cART was started when immunodeficiency was severe rather than mild or advanced. Conclusions: cART increased CD4 percentages among HIV-infected children in a resource-deprived setting, as previously noted among children in the United States. More gradual and protracted recovery in children with lower baseline CD4 percentages supports earlier initiation of pediatric cART.

AB - Background: The long-term effects of combined antiretroviral therapy (cART) on CD4 percentage in HIV-infected children are incompletely understood, with evidence from resource-deprived areas particularly scarce even though most children with HIV live in such settings. We sought to describe this relationship. Methods: Observational longitudinal data from cART-naive children enrolled between December 2004 and May 2010 into an HIV care and treatment program in Kinshasa, Democratic Republic of Congo were analyzed. To estimate the effect of cART on CD4 percentage while accounting for time-dependent confounders affected by prior exposure to cART, a marginal structural linear mean model was used. Results: Seven hundred ninety children were active for 2090 person-years and a median of 31 months; 619 (78%) initiated cART. At baseline, 405 children (51%) were in HIV clinical stage 3 or 4; 528 (67%) had advanced or severe immunodeficiency. Compared with no cART, the estimated absolute rise in CD4 percentage was 6.8% [95% confidence interval (CI), 4.7% to 8.9%] after 6 months of cART, 8.6% (95% CI, 7.0% to 10.2%) after 12 months, and 20.5% (95% CI, 16.1% to 24.9%) after 60 months. cART-mediated CD4 percentage gains were slowest but greatest among children with baseline CD4 percentage <15. The cumulative incidence of recovery to "not significant" World Health Organization age-specific immunodeficiency was lower if cART was started when immunodeficiency was severe rather than mild or advanced. Conclusions: cART increased CD4 percentages among HIV-infected children in a resource-deprived setting, as previously noted among children in the United States. More gradual and protracted recovery in children with lower baseline CD4 percentages supports earlier initiation of pediatric cART.

KW - antiretroviral therapy

KW - CD4

KW - Democratic Republic of the Congo

KW - HIV

KW - models

KW - paediatrics

KW - statistical

UR - http://www.scopus.com/inward/record.url?scp=84865724455&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84865724455&partnerID=8YFLogxK

U2 - 10.1097/QAI.0b013e31825bd9b7

DO - 10.1097/QAI.0b013e31825bd9b7

M3 - Article

C2 - 22732464

AN - SCOPUS:84865724455

VL - 61

SP - 90

EP - 98

JO - Journal of Acquired Immune Deficiency Syndromes

JF - Journal of Acquired Immune Deficiency Syndromes

SN - 1525-4135

IS - 1

ER -