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Early severe HIV disease precedes early antiretroviral therapy in infants: Are we too late?

OBJECTIVE: To describe the degree of HIV disease progression in infants initiating antiretroviral therapy (ART) by three months of age in a programmatic setting in South Africa. DESIGN: This was a programmatic cohort study. METHODS: Electronic and manual data extraction from databases and antiretrov...

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Autores principales: Innes, Steve, Lazarus, Erica, Otwombe, Kennedy, Liberty, Afaaf, Germanus, Ramona, Van Rensburg, Anita Janse, Grobbelaar, Nelis, Hurter, Theunis, Eley, Brian, Violari, Avy, Cotton, Mark F
Formato: Online Artículo Texto
Lenguaje:English
Publicado: International AIDS Society 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4056161/
https://www.ncbi.nlm.nih.gov/pubmed/24925044
http://dx.doi.org/10.7448/IAS.17.1.18914
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author Innes, Steve
Lazarus, Erica
Otwombe, Kennedy
Liberty, Afaaf
Germanus, Ramona
Van Rensburg, Anita Janse
Grobbelaar, Nelis
Hurter, Theunis
Eley, Brian
Violari, Avy
Cotton, Mark F
author_facet Innes, Steve
Lazarus, Erica
Otwombe, Kennedy
Liberty, Afaaf
Germanus, Ramona
Van Rensburg, Anita Janse
Grobbelaar, Nelis
Hurter, Theunis
Eley, Brian
Violari, Avy
Cotton, Mark F
author_sort Innes, Steve
collection PubMed
description OBJECTIVE: To describe the degree of HIV disease progression in infants initiating antiretroviral therapy (ART) by three months of age in a programmatic setting in South Africa. DESIGN: This was a programmatic cohort study. METHODS: Electronic and manual data extraction from databases and antiretroviral registers in 20 public clinics in Cape Town and electronic data extraction from a large ART service at Chris Hani Baragwanath Hospital in Soweto were performed. Records of all infants initiated on ART by three months of age between June 2007 and September 2010 were extracted. Demographics, immunological and clinical stage at ART initiation were analyzed descriptively by chi-square, two-sample t-test and Kaplan–Meier methods. RESULTS: A total of 403 records were identified: 88 in Cape Town and 315 in Soweto. Median age at ART initiation was 8.4 [interquartile range (IQR): 7.2–9.7] weeks. At ART initiation, 250 infants (62%) had advanced HIV disease (CD4% <25% or absolute CD4<1500 cells/mm(3) or WHO clinical Stage 3 or 4). Median age at ART initiation by site was 10.3 (IQR: 8.2–11.9) weeks in Cape Town and 8.6 (IQR: 7.7–10.0) weeks in Soweto infants (p<0.0001). In Cape Town, 73 infants (83%) had advanced HIV disease at ART initiation, compared to 177 infants (56%) in Soweto (p<0.0001). On logistic regression, each month increase in age at ART initiation lowered the odds of initiating ART in an optimal state (OR: 0.56, CI: 0.36–0.94) and increased the odds of advanced HIV disease at ART initiation (OR: 1.69, CI: 1.05–2.71). CONCLUSIONS: ART initiation by three months of age may not adequately prevent disease progression. New emphasis on early diagnosis and rapid initiation of ART in the first weeks of life are essential to further reduce infant mortality.
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spelling pubmed-40561612014-06-13 Early severe HIV disease precedes early antiretroviral therapy in infants: Are we too late? Innes, Steve Lazarus, Erica Otwombe, Kennedy Liberty, Afaaf Germanus, Ramona Van Rensburg, Anita Janse Grobbelaar, Nelis Hurter, Theunis Eley, Brian Violari, Avy Cotton, Mark F J Int AIDS Soc Short Report OBJECTIVE: To describe the degree of HIV disease progression in infants initiating antiretroviral therapy (ART) by three months of age in a programmatic setting in South Africa. DESIGN: This was a programmatic cohort study. METHODS: Electronic and manual data extraction from databases and antiretroviral registers in 20 public clinics in Cape Town and electronic data extraction from a large ART service at Chris Hani Baragwanath Hospital in Soweto were performed. Records of all infants initiated on ART by three months of age between June 2007 and September 2010 were extracted. Demographics, immunological and clinical stage at ART initiation were analyzed descriptively by chi-square, two-sample t-test and Kaplan–Meier methods. RESULTS: A total of 403 records were identified: 88 in Cape Town and 315 in Soweto. Median age at ART initiation was 8.4 [interquartile range (IQR): 7.2–9.7] weeks. At ART initiation, 250 infants (62%) had advanced HIV disease (CD4% <25% or absolute CD4<1500 cells/mm(3) or WHO clinical Stage 3 or 4). Median age at ART initiation by site was 10.3 (IQR: 8.2–11.9) weeks in Cape Town and 8.6 (IQR: 7.7–10.0) weeks in Soweto infants (p<0.0001). In Cape Town, 73 infants (83%) had advanced HIV disease at ART initiation, compared to 177 infants (56%) in Soweto (p<0.0001). On logistic regression, each month increase in age at ART initiation lowered the odds of initiating ART in an optimal state (OR: 0.56, CI: 0.36–0.94) and increased the odds of advanced HIV disease at ART initiation (OR: 1.69, CI: 1.05–2.71). CONCLUSIONS: ART initiation by three months of age may not adequately prevent disease progression. New emphasis on early diagnosis and rapid initiation of ART in the first weeks of life are essential to further reduce infant mortality. International AIDS Society 2014-06-11 /pmc/articles/PMC4056161/ /pubmed/24925044 http://dx.doi.org/10.7448/IAS.17.1.18914 Text en © 2014 Innes S et al; licensee International AIDS Society http://creativecommons.org/licenses/by/3.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Short Report
Innes, Steve
Lazarus, Erica
Otwombe, Kennedy
Liberty, Afaaf
Germanus, Ramona
Van Rensburg, Anita Janse
Grobbelaar, Nelis
Hurter, Theunis
Eley, Brian
Violari, Avy
Cotton, Mark F
Early severe HIV disease precedes early antiretroviral therapy in infants: Are we too late?
title Early severe HIV disease precedes early antiretroviral therapy in infants: Are we too late?
title_full Early severe HIV disease precedes early antiretroviral therapy in infants: Are we too late?
title_fullStr Early severe HIV disease precedes early antiretroviral therapy in infants: Are we too late?
title_full_unstemmed Early severe HIV disease precedes early antiretroviral therapy in infants: Are we too late?
title_short Early severe HIV disease precedes early antiretroviral therapy in infants: Are we too late?
title_sort early severe hiv disease precedes early antiretroviral therapy in infants: are we too late?
topic Short Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4056161/
https://www.ncbi.nlm.nih.gov/pubmed/24925044
http://dx.doi.org/10.7448/IAS.17.1.18914
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