Temporal Trends in the Characteristics of Children at Antiretroviral Therapy Initiation in Southern Africa: The IeDEA-SA CollaborationReport as inadecuate




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Background

Since 2005, increasing numbers of children have started antiretroviral therapy ART in sub-Saharan Africa and, in recent years, WHO and country treatment guidelines have recommended ART initiation for all infants and very young children, and at higher CD4 thresholds for older children. We examined temporal changes in patient and regimen characteristics at ART start using data from 12 cohorts in 4 countries participating in the IeDEA-SA collaboration.

Methodology-Principal Findings

Data from 30,300 ART-naïve children aged <16 years at ART initiation who started therapy between 2005 and 2010 were analysed. We examined changes in median values for continuous variables using the Cuzick-s test for trend over time. We also examined changes in the proportions of patients with particular disease severity characteristics expressed as a binary variable e.g. WHO Stage III-IV vs I-II using logistic regression. Between 2005 and 2010 the number of children starting ART each year increased and median age declined from 63 months 2006 to 56 months 2010. Both the proportion of children <1 year and ≥10 years of age increased from 12 to 19% and 18 to 22% respectively. Children had less severe disease at ART initiation in later years with significant declines in the percentage with severe immunosuppression 81 to 63%, WHO Stage III-IV disease 75 to 62%, severe anemia 12 to 7% and weight-for-age z-score<−3 31 to 28%. Similar results were seen when restricting to infants with significant declines in the proportion with severe immunodeficiency 98 to 82% and Stage III-IV disease 81 to 63%. First-line regimen use followed country guidelines.

Conclusions-Significance

Between 2005 and 2010 increasing numbers of children have initiated ART with a decline in disease severity at start of therapy. However, even in 2010, a substantial number of infants and children started ART with advanced disease. These results highlight the importance of efforts to improve access to HIV diagnostic testing and ART in children.



Author: Mary-Ann Davies , Sam Phiri, Robin Wood, Maureen Wellington, Vivian Cox, Carolyn Bolton-Moore, Venessa Timmerman, Harry Moultrie,

Source: http://plos.srce.hr/



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