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Treatment outcomes among children younger than five years living with HIV in rural Zambia, 2008–2018: a cohort study
BACKGROUND: HIV testing and treatment guidelines for children in sub-Saharan Africa have evolved over time, such that children are now treated at younger ages. The objective of this study was to describe the treatment experience for immunologic, virologic, and growth outcomes among HIV-infected Zamb...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8278691/ https://www.ncbi.nlm.nih.gov/pubmed/34261465 http://dx.doi.org/10.1186/s12887-021-02793-y |
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author | Schue, Jessica L. van Dijk, Janneke H. Hamangaba, Francis Hamahuwa, Mutinta Moyo, Nkumbula Thuma, Philip E. Moss, William J. Sutcliffe, Catherine G. |
author_facet | Schue, Jessica L. van Dijk, Janneke H. Hamangaba, Francis Hamahuwa, Mutinta Moyo, Nkumbula Thuma, Philip E. Moss, William J. Sutcliffe, Catherine G. |
author_sort | Schue, Jessica L. |
collection | PubMed |
description | BACKGROUND: HIV testing and treatment guidelines for children in sub-Saharan Africa have evolved over time, such that children are now treated at younger ages. The objective of this study was to describe the treatment experience for immunologic, virologic, and growth outcomes among HIV-infected Zambian children younger than 5 years of age from 2008 to 2018. METHODS: Participants enrolled in a clinical cohort study in Macha, Zambia and initiating antiretroviral treatment before 5 years of age between 2008 and 2015 were included in the analysis and followed up to the end of 2018. Outcomes, including growth, CD4+ T-cell percentage, viral suppression, and mortality, were evaluated among all children using longitudinal and survival analyses. Comparisons by age at treatment initiation (< 1, 1 to < 2, and 2 to < 5 years) were also evaluated. RESULTS: Three hundred eighty-one children initiating treatment before 5 years of age between 2008 and 2015 were included in the analysis. Growth metrics and CD4+ T-cell percentage improved over time after treatment initiation. However, 20% of children remained underweight and 40% of children remained stunted after the first 36 months of treatment. 85% of children had a viral load < 400 copies/mL after 12 months of treatment. However, children < 1 year at treatment initiation were more likely to have a detectable viral load in the first 12 months of treatment and less likely to achieve viral suppression compared to older children. Mortality was highest in the first 12 months of treatment, among underweight children, and among children initiating treatment in 2008–2010 compared to 2011–2015. CONCLUSIONS: Most children initiating antiretroviral treatment from 2008 to 2015 in rural Zambia responded well to treatment. However, many children remained underweight and stunted, and experienced high mortality rates during the first few months of treatment. This supports continued efforts to improve early infant diagnosis, nutritional support, and pediatric drug formulations. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12887-021-02793-y. |
format | Online Article Text |
id | pubmed-8278691 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-82786912021-07-15 Treatment outcomes among children younger than five years living with HIV in rural Zambia, 2008–2018: a cohort study Schue, Jessica L. van Dijk, Janneke H. Hamangaba, Francis Hamahuwa, Mutinta Moyo, Nkumbula Thuma, Philip E. Moss, William J. Sutcliffe, Catherine G. BMC Pediatr Research BACKGROUND: HIV testing and treatment guidelines for children in sub-Saharan Africa have evolved over time, such that children are now treated at younger ages. The objective of this study was to describe the treatment experience for immunologic, virologic, and growth outcomes among HIV-infected Zambian children younger than 5 years of age from 2008 to 2018. METHODS: Participants enrolled in a clinical cohort study in Macha, Zambia and initiating antiretroviral treatment before 5 years of age between 2008 and 2015 were included in the analysis and followed up to the end of 2018. Outcomes, including growth, CD4+ T-cell percentage, viral suppression, and mortality, were evaluated among all children using longitudinal and survival analyses. Comparisons by age at treatment initiation (< 1, 1 to < 2, and 2 to < 5 years) were also evaluated. RESULTS: Three hundred eighty-one children initiating treatment before 5 years of age between 2008 and 2015 were included in the analysis. Growth metrics and CD4+ T-cell percentage improved over time after treatment initiation. However, 20% of children remained underweight and 40% of children remained stunted after the first 36 months of treatment. 85% of children had a viral load < 400 copies/mL after 12 months of treatment. However, children < 1 year at treatment initiation were more likely to have a detectable viral load in the first 12 months of treatment and less likely to achieve viral suppression compared to older children. Mortality was highest in the first 12 months of treatment, among underweight children, and among children initiating treatment in 2008–2010 compared to 2011–2015. CONCLUSIONS: Most children initiating antiretroviral treatment from 2008 to 2015 in rural Zambia responded well to treatment. However, many children remained underweight and stunted, and experienced high mortality rates during the first few months of treatment. This supports continued efforts to improve early infant diagnosis, nutritional support, and pediatric drug formulations. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12887-021-02793-y. BioMed Central 2021-07-14 /pmc/articles/PMC8278691/ /pubmed/34261465 http://dx.doi.org/10.1186/s12887-021-02793-y Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Schue, Jessica L. van Dijk, Janneke H. Hamangaba, Francis Hamahuwa, Mutinta Moyo, Nkumbula Thuma, Philip E. Moss, William J. Sutcliffe, Catherine G. Treatment outcomes among children younger than five years living with HIV in rural Zambia, 2008–2018: a cohort study |
title | Treatment outcomes among children younger than five years living with HIV in rural Zambia, 2008–2018: a cohort study |
title_full | Treatment outcomes among children younger than five years living with HIV in rural Zambia, 2008–2018: a cohort study |
title_fullStr | Treatment outcomes among children younger than five years living with HIV in rural Zambia, 2008–2018: a cohort study |
title_full_unstemmed | Treatment outcomes among children younger than five years living with HIV in rural Zambia, 2008–2018: a cohort study |
title_short | Treatment outcomes among children younger than five years living with HIV in rural Zambia, 2008–2018: a cohort study |
title_sort | treatment outcomes among children younger than five years living with hiv in rural zambia, 2008–2018: a cohort study |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8278691/ https://www.ncbi.nlm.nih.gov/pubmed/34261465 http://dx.doi.org/10.1186/s12887-021-02793-y |
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