Annette H Sohn1, Pagakrong Lumbiganon2, Nia Kurniati3, Keswadee Lapphra4, Matthew Law5, Viet C Do6, Lam Van Nguyen7, Khanh H Truong8, Dewi K Wati9, Pradthana Ounchanum10, Thanyawee Puthanakit11, Tavitiya Sudjaritruk12, Penh S Ly13, Nik K N Yusoff14, Sieu M Fong15, Thahira J Mohamed16, Revathy Nallusamy17, Nagalingaswaran Kumarasamy18, Azar Kariminia5. 1. TREAT Asia, amfAR - The Foundation for AIDS Research, Bangkok. 2. Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. 3. Cipto Mangunkusumo - Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia. 4. Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. 5. The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia. 6. Children's Hospital 2, Ho Chi Minh City. 7. National Hospital of Pediatrics, Hanoi. 8. Children's Hospital 1, Ho Chi Minh City, Vietnam. 9. Sanglah Hospital, Udayana University, Bali, Indonesia. 10. Chiangrai Prachanukroh Hospital, Chiang Rai. 11. Department of Pediatrics, Faculty of Medicine and Research Unit in Pediatric and Infectious Diseases, Chulalongkorn University, Bangkok. 12. Department of Pediatrics, Faculty of Medicine, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand. 13. National Centre for HIV/AIDS, Dermatology and STDs, Phnom Penh, Cambodia. 14. Hospital Raja Perempuan Zainab II, Kota Bharu. 15. Hospital Likas, Kota Kinabalu. 16. Pediatric Institute, Hospital Kuala Lumpur, Kuala Lumpur. 17. Penang Hospital, Penang, Malaysia. 18. VHS-Infectious Diseases Medical Centre, Chennai, India.
Abstract
OBJECTIVE: To implement a standardized cause of death reporting and review process to systematically disaggregate causes of HIV-related deaths in a cohort of Asian children and adolescents. DESIGN: Death-related data were retrospectively and prospectively assessed in a longitudinal regional cohort study. METHODS: Children under routine HIV care at sites in Cambodia, India, Indonesia, Malaysia, Thailand, and Vietnam between 2008 and 2017 were followed. Causes of death were reported and then independently and centrally reviewed. Predictors were compared using competing risks survival regression analyses. RESULTS: Among 5918 children, 5523 (93%; 52% male) had ever been on combination antiretroviral therapy. Of 371 (6.3%) deaths, 312 (84%) occurred in those with a history of combination antiretroviral therapy (crude all-cause mortality 9.6 per 1000 person-years; total follow-up time 32 361 person-years). In this group, median age at death was 7.0 (2.9-13) years; median CD4 cell count was 73 (16-325) cells/μl. The most common underlying causes of death were pneumonia due to unspecified pathogens (17%), tuberculosis (16%), sepsis (8.0%), and AIDS (6.7%); 12% of causes were unknown. These clinical diagnoses were further grouped into AIDS-related infections (22%) and noninfections (5.8%), and non-AIDS-related infections (47%) and noninfections (11%); with 12% unknown, 2.2% not reviewed. Higher CD4 cell count and better weight-for-age z-score were protective against death. CONCLUSION: Our standardized cause of death assessment provides robust data to inform regional resource allocation for pediatric diagnostic evaluations and prioritization of clinical interventions, and highlight the continued importance of opportunistic and nonopportunistic infections as causes of death in our cohort.
OBJECTIVE: To implement a standardized cause of death reporting and review process to systematically disaggregate causes of HIV-related deaths in a cohort of Asian children and adolescents. DESIGN: Death-related data were retrospectively and prospectively assessed in a longitudinal regional cohort study. METHODS: Children under routine HIV care at sites in Cambodia, India, Indonesia, Malaysia, Thailand, and Vietnam between 2008 and 2017 were followed. Causes of death were reported and then independently and centrally reviewed. Predictors were compared using competing risks survival regression analyses. RESULTS: Among 5918 children, 5523 (93%; 52% male) had ever been on combination antiretroviral therapy. Of 371 (6.3%) deaths, 312 (84%) occurred in those with a history of combination antiretroviral therapy (crude all-cause mortality 9.6 per 1000 person-years; total follow-up time 32 361 person-years). In this group, median age at death was 7.0 (2.9-13) years; median CD4 cell count was 73 (16-325) cells/μl. The most common underlying causes of death were pneumonia due to unspecified pathogens (17%), tuberculosis (16%), sepsis (8.0%), and AIDS (6.7%); 12% of causes were unknown. These clinical diagnoses were further grouped into AIDS-related infections (22%) and noninfections (5.8%), and non-AIDS-related infections (47%) and noninfections (11%); with 12% unknown, 2.2% not reviewed. Higher CD4 cell count and better weight-for-age z-score were protective against death. CONCLUSION: Our standardized cause of death assessment provides robust data to inform regional resource allocation for pediatric diagnostic evaluations and prioritization of clinical interventions, and highlight the continued importance of opportunistic and nonopportunistic infections as causes of death in our cohort.
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
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