The effect of highly active antiretroviral therapy on the survival of HIV-infected children in a resource-deprived setting : a cohort study

Edmonds, Andrew; Yotebieng, Marcel; Lusiama, Jean; Matumona, Yori; Kitetele, Faustin; Napravnik, Sonia; Cole, Stephen R.; Van Rie, Annelies; Behets, Frieda

doi:10.1371/JOURNAL.PMED.1001044

Title

The effect of highly active antiretroviral therapy on the survival of HIV-infected children in a resource-deprived setting : a cohort study

Author

Edmonds, Andrew

Yotebieng, Marcel

Lusiama, Jean

Matumona, Yori

Kitetele, Faustin

Napravnik, Sonia

Cole, Stephen R.

Van Rie, Annelies

Behets, Frieda

Abstract

Background: The effect of highly active antiretroviral therapy (HAART) on the survival of HIV-infected children has not been well quantified. Because most pediatric HIV occurs in low-and middle-income countries, our objective was to provide a first estimate of this effect among children living in a resource-deprived setting. Methods and Findings: Observational data from HAART-naive children enrolled into an HIV care and treatment program in Kinshasa, Democratic Republic of the Congo, between December 2004 and May 2010 were analyzed. We used marginal structural models to estimate the effect of HAART on survival while accounting for time-dependent confounders affected by exposure. At the start of follow-up, the median age of the 790 children was 5.9 y, 528 (66.8%) had advanced or severe immunodeficiency, and 405 (51.3%) were in HIV clinical stage 3 or 4. The children were observed for a median of 31.2 mo and contributed a total of 2,089.8 person-years. Eighty children (10.1%) died, 619 (78.4%) initiated HAART, six (0.8%) transferred to a different care provider, and 76 (9.6%) were lost to follow-up. The mortality rate was 3.2 deaths per 100 person-years (95% confidence interval [CI] 2.4-4.2) during receipt of HAART and 6.0 deaths per 100 person-years (95% CI 4.1-8.6) during receipt of primary HIV care only. The mortality hazard ratio comparing HAART with no HAART from a marginal structural model was 0.25 (95% CI 0.06-0.95). Conclusions: HAART reduced the hazard of mortality in HIV-infected children in Kinshasa by 75%, an estimate that is similar in magnitude but with lower precision than the reported effect of HAART on survival among children in the United States.

Language

English

Source (journal)

PLoS medicine. - San Francisco, Calif.

Publication

San Francisco, Calif. : 2011

ISSN

1549-1277 [print]

1549-1676 [online]

DOI

10.1371/JOURNAL.PMED.1001044

Volume/pages