BACKGROUND: Previous observational studies found highly active antiretroviral therapy (HAART) to be associated with improved survival among human immunodeficiency virus (HIV)-infected children and adolescents. However, these studies had limited follow-up of HIV-infected children undergoing HAART. Given that HIV infection is chronic and that exposure to HAART is likely to be life-long, there is a need to evaluate the long-term effect of HAART on survival in this population. METHODS: The study included 1236 children and adolescents who were perinatally infected with HIV, who were on study or enrolled after January 1996 in a United States-based multicenter prospective cohort study (Pediatric AIDS Clinical Trials Group 219/219C), and who were not receiving HAART at baseline; subjects were observed for a maximum of 10 years through June 2006. A weighted Cox regression model was used to estimate the effect of HAART on survival, appropriately adjusted for time-varying confounding by severity. RESULTS: At the end of the 10-year follow-up period (median duration of follow-up, 6.3 years; interquartile range, 4.3-9.8 years), 70% of participants had initiated HAART. Lower CD4 cell percentages, total lymphocyte counts, and albumin levels were associated with an increased probability of initiating HAART. Eighty-five deaths were observed, and the mortality hazard ratio associated with HAART, compared with non-HAART regimens, was 0.24 after adjusting for measured confounding by severity (95% confidence interval, 0.11-0.51). CONCLUSIONS: The use of HAART was highly effective in reducing mortality during the period 1996-2006 among children and adolescents infected with HIV. With improved long-term survival, continued follow-up is necessary to evaluate the effects of prolonged use of HAART on potential adverse events, immune function, growth, sexual maturation, and quality of life in this population.
BACKGROUND: Previous observational studies found highly active antiretroviral therapy (HAART) to be associated with improved survival among human immunodeficiency virus (HIV)-infectedchildren and adolescents. However, these studies had limited follow-up of HIV-infectedchildren undergoing HAART. Given that HIV infection is chronic and that exposure to HAART is likely to be life-long, there is a need to evaluate the long-term effect of HAART on survival in this population. METHODS: The study included 1236 children and adolescents who were perinatally infected with HIV, who were on study or enrolled after January 1996 in a United States-based multicenter prospective cohort study (Pediatric AIDS Clinical Trials Group 219/219C), and who were not receiving HAART at baseline; subjects were observed for a maximum of 10 years through June 2006. A weighted Cox regression model was used to estimate the effect of HAART on survival, appropriately adjusted for time-varying confounding by severity. RESULTS: At the end of the 10-year follow-up period (median duration of follow-up, 6.3 years; interquartile range, 4.3-9.8 years), 70% of participants had initiated HAART. Lower CD4 cell percentages, total lymphocyte counts, and albumin levels were associated with an increased probability of initiating HAART. Eighty-five deaths were observed, and the mortality hazard ratio associated with HAART, compared with non-HAART regimens, was 0.24 after adjusting for measured confounding by severity (95% confidence interval, 0.11-0.51). CONCLUSIONS: The use of HAART was highly effective in reducing mortality during the period 1996-2006 among children and adolescents infected with HIV. With improved long-term survival, continued follow-up is necessary to evaluate the effects of prolonged use of HAART on potential adverse events, immune function, growth, sexual maturation, and quality of life in this population.
Authors: Marco T Luque; Cathy A Jenkins; Bryan E Shepherd; Denis Padgett; Vanessa Rouzier; Regina Célia M Succi; Daisy M Machado; Catherine C McGowan; Sten H Vermund; Jorge A Pinto Journal: J Pediatr Date: 2017-01-09 Impact factor: 4.406
Authors: Bill G Kapogiannis; Minn M Soe; Steven R Nesheim; Elaine J Abrams; Rosalind J Carter; John Farley; Paul Palumbo; Linda J Koenig; Marc Bulterys Journal: Clin Infect Dis Date: 2011-11 Impact factor: 9.079
Authors: Gayatri Mirani; Paige L Williams; Miriam Chernoff; Mark J Abzug; Myron J Levin; George R Seage; James M Oleske; Murli U Purswani; Rohan Hazra; Shirley Traite; Bonnie Zimmer; Russell B Van Dyke Journal: Clin Infect Dis Date: 2015-08-12 Impact factor: 9.079
Authors: Bernadette Ngeno; Anthony Waruru; Irene Inwani; Lucy Nganga; Evelyn Ngugi Wangari; Abraham Katana; Anthony Gichangi; Ann Mwangi; Irene Mukui; George W Rutherford Journal: J Adolesc Health Date: 2018-10-25 Impact factor: 5.012