The effect of highly active antiretroviral therapy on the survival of HIV-infected children in a resource-deprived setting: A cohort study

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

Research output: Contribution to journalArticle

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Abstract

Background: The effect of highly active antiretroviral therapy (HAART) on the survival of HIV-infected children has not been well quantified. Because most pediatric HIV occurs in low- and middle-income countries, our objective was to provide a first estimate of this effect among children living in a resource-deprived setting. Methods and Findings: Observational data from HAART-naïve children enrolled into an HIV care and treatment program in Kinshasa, Democratic Republic of the Congo, between December 2004 and May 2010 were analyzed. We used marginal structural models to estimate the effect of HAART on survival while accounting for time-dependent confounders affected by exposure. At the start of follow-up, the median age of the 790 children was 5.9 y, 528 (66.8%) had advanced or severe immunodeficiency, and 405 (51.3%) were in HIV clinical stage 3 or 4. The children were observed for a median of 31.2 mo and contributed a total of 2,089.8 person-years. Eighty children (10.1%) died, 619 (78.4%) initiated HAART, six (0.8%) transferred to a different care provider, and 76 (9.6%) were lost to follow-up. The mortality rate was 3.2 deaths per 100 person-years (95% confidence interval [CI] 2.4-4.2) during receipt of HAART and 6.0 deaths per 100 person-years (95% CI 4.1-8.6) during receipt of primary HIV care only. The mortality hazard ratio comparing HAART with no HAART from a marginal structural model was 0.25 (95% CI 0.06-0.95). Conclusions: HAART reduced the hazard of mortality in HIV-infected children in Kinshasa by 75%, an estimate that is similar in magnitude but with lower precision than the reported effect of HAART on survival among children in the United States.

Original languageEnglish (US)
Article numbere1001044
JournalPLoS Medicine
Volume8
Issue number6
DOIs
StatePublished - Jun 1 2011
Externally publishedYes

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Highly Active Antiretroviral Therapy
Cohort Studies
HIV
Survival
Structural Models
Confidence Intervals
Mortality
Democratic Republic of the Congo
Lost to Follow-Up
Primary Health Care
Pediatrics

ASJC Scopus subject areas

  • Medicine(all)

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The effect of highly active antiretroviral therapy on the survival of HIV-infected children in a resource-deprived setting : A cohort study. / Edmonds, Andrew; Yotebieng, Marcel; Lusiama, Jean; Matumona, Yori; Kitetele, Faustin; Napravnik, Sonia; Cole, Stephen R.; van Rie, Annelies; Behets, Frieda.

In: PLoS Medicine, Vol. 8, No. 6, e1001044, 01.06.2011.

Research output: Contribution to journalArticle

Edmonds, Andrew ; Yotebieng, Marcel ; Lusiama, Jean ; Matumona, Yori ; Kitetele, Faustin ; Napravnik, Sonia ; Cole, Stephen R. ; van Rie, Annelies ; Behets, Frieda. / The effect of highly active antiretroviral therapy on the survival of HIV-infected children in a resource-deprived setting : A cohort study. In: PLoS Medicine. 2011 ; Vol. 8, No. 6.
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abstract = "Background: The effect of highly active antiretroviral therapy (HAART) on the survival of HIV-infected children has not been well quantified. Because most pediatric HIV occurs in low- and middle-income countries, our objective was to provide a first estimate of this effect among children living in a resource-deprived setting. Methods and Findings: Observational data from HAART-na{\"i}ve children enrolled into an HIV care and treatment program in Kinshasa, Democratic Republic of the Congo, between December 2004 and May 2010 were analyzed. We used marginal structural models to estimate the effect of HAART on survival while accounting for time-dependent confounders affected by exposure. At the start of follow-up, the median age of the 790 children was 5.9 y, 528 (66.8{\%}) had advanced or severe immunodeficiency, and 405 (51.3{\%}) were in HIV clinical stage 3 or 4. The children were observed for a median of 31.2 mo and contributed a total of 2,089.8 person-years. Eighty children (10.1{\%}) died, 619 (78.4{\%}) initiated HAART, six (0.8{\%}) transferred to a different care provider, and 76 (9.6{\%}) were lost to follow-up. The mortality rate was 3.2 deaths per 100 person-years (95{\%} confidence interval [CI] 2.4-4.2) during receipt of HAART and 6.0 deaths per 100 person-years (95{\%} CI 4.1-8.6) during receipt of primary HIV care only. The mortality hazard ratio comparing HAART with no HAART from a marginal structural model was 0.25 (95{\%} CI 0.06-0.95). Conclusions: HAART reduced the hazard of mortality in HIV-infected children in Kinshasa by 75{\%}, an estimate that is similar in magnitude but with lower precision than the reported effect of HAART on survival among children in the United States.",
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AU - Edmonds, Andrew

AU - Yotebieng, Marcel

AU - Lusiama, Jean

AU - Matumona, Yori

AU - Kitetele, Faustin

AU - Napravnik, Sonia

AU - Cole, Stephen R.

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