10 research outputs found
Growth and CD4 patterns of adolescents living with perinatally acquired HIV worldwide, a CIPHER cohort collaboration analysis
Introduction: Adolescents living with HIV are subject to multiple co-morbidities, including growth retardation and immunodeficiency. We describe growth and CD4 evolution during adolescence using data from the Collaborative Initiative for Paediatric HIV Education and Research (CIPHER) global project. Methods: Data were collected between 1994 and 2015 from 11 CIPHER networks worldwide. Adolescents with perinatally acquired HIV infection (APH) who initiated antiretroviral therapy (ART) before age 10 years, with at least one height or CD4 count measurement while aged 10â17 years, were included. Growth was measured using height-for-age Z-scores (HAZ, stunting if <-2 SD, WHO growth charts). Linear mixed-effects models were used to study the evolution of each outcome between ages 10 and 17. For growth, sex-specific models with fractional polynomials were used to model non-linear relationships for age at ART initiation, HAZ at age 10 and time, defined as current age from 10 to 17 years of age. Results: A total of 20,939 and 19,557 APH were included for the growth and CD4 analyses, respectively. Half were females, two-thirds lived in East and Southern Africa, and median age at ART initiation ranged from <3 years in North America and Europe to >7 years in sub-Saharan African regions. At age 10, stunting ranged from 6% in North America and Europe to 39% in the Asia-Pacific; 19% overall had CD4 counts <500 cells/mm3. Across adolescence, higher HAZ was observed in females and among those in high-income countries. APH with stunting at age 10 and those with late ART initiation (after age 5) had the largest HAZ gains during adolescence, but these gains were insufficient to catch-up with non-stunted, early ART-treated adolescents. From age 10 to 16 years, mean CD4 counts declined from 768 to 607 cells/mm3. This decline was observed across all regions, in males and females. Conclusions: Growth patterns during adolescence differed substantially by sex and region, while CD4 patterns were similar, with an observed CD4 decline that needs further investigation. Early diagnosis and timely initiation of treatment in early childhood to prevent growth retardation and immunodeficiency are critical to improving APH growth and CD4 outcomes by the time they reach adulthood
Feasibility of Implementing an Early Intervention Program in an Urban Low-Income Setting to Improve Neurodevelopmental Outcome in Survivors Following Birth Asphyxia
Birth asphyxia is a leading cause of neonatal mortality, accounting for 23% of neonatal deaths. An early intervention program (EIP) could improve neuro-developmental outcomes in survivors of birth asphyxia, but its feasibility in low-income countries has not been tested. Â In this pilot study in Zambia, eighty live-born infants > 1500 g of weight who had birth asphyxia and received resuscitation with bag and mask were enrolled for a study of standard care or EIP. Mothers/babies pairs were randomized into control (standard care) and intervention (EIP) groups and were followed up at home on a bi-weekly basis from 8 weeks to 8 months of age. Forty two mothers/babies (52.5%) completed the study at 8 months. Reasons for not completing the study were: 19 (50.1%) were lost to follow up, 16 (42.1%) withdrew, and 3 (7.8%) died. Follow-up to 8 months of age was not feasible for the majority in a large urban city with a low income population. Thus, interventions for children who have suffered birth asphyxia that require additional health care visits may not be currently feasible in the setting tested. There is a need to conduct further EIP studies to determine ways to improve follow up rates of children surviving birth asphyxia. Integrating early intervention programs with other successful health programs, such as the existing immunization programs, may improve follow up rates
Growth and CD4 patterns of adolescents living with perinatally acquired HIV worldwide, a CIPHER cohort collaboration analysis
INTRODUCTION: Adolescents living with HIV are subject to multiple co-morbidities, including growth retardation and immunodeficiency. We describe growth and CD4 evolution during adolescence using data from the Collaborative Initiative for Paediatric HIV Education and Research (CIPHER) global project. METHODS: Data were collected between 1994 and 2015 from 11 CIPHER networks worldwide. Adolescents with perinatally acquired HIV infection (APH) who initiated antiretroviral therapy (ART) before age 10 years, with at least one height or CD4 count measurement while aged 10-17 years, were included. Growth was measured using height-for-age Z-scores (HAZ, stunting if 7 years in sub-Saharan African regions. At age 10, stunting ranged from 6% in North America and Europe to 39% in the Asia-Pacific; 19% overall had CD4 counts <500 cells/mm3 . Across adolescence, higher HAZ was observed in females and among those in high-income countries. APH with stunting at age 10 and those with late ART initiation (after age 5) had the largest HAZ gains during adolescence, but these gains were insufficient to catch-up with non-stunted, early ART-treated adolescents. From age 10 to 16 years, mean CD4 counts declined from 768 to 607 cells/mm3 . This decline was observed across all regions, in males and females. CONCLUSIONS: Growth patterns during adolescence differed substantially by sex and region, while CD4 patterns were similar, with an observed CD4 decline that needs further investigation. Early diagnosis and timely initiation of treatment in early childhood to prevent growth retardation and immunodeficiency are critical to improving APH growth and CD4 outcomes by the time they reach adulthood
Outcomes of secondâline antiretroviral therapy among children living with HIV: a global cohort analysis
INTRODUCTION: Limited data describe outcomes on secondâline antiretroviral therapy (ART) among children globally. Our objective was to contribute data on outcomes among children living with HIV after initiation of secondâline ART in the context of routine care within a large global cohort collaboration. METHODS: Patientâlevel data from 1993 through 2015 from 11 paediatric HIV cohorts were pooled. Characteristics at switch and through two years of followâup were summarized for children who switched to secondâline ART after starting a standard firstâline regimen in North America, Latin America, Europe, Asia, Southern Africa (South Africa & Botswana) and the rest of subâSaharan Africa (SSA). Cumulative incidences of mortality and loss to followâup (LTFU) were estimated using a competing risks framework. RESULTS: Of the 85,389 children on firstâline ART, 3,555 (4%) switched to secondâline after a median of 2.8 years on ART (IQR: 1.6, 4.7); 69% were from Southern Africa or SSA and 86% of secondâline regimens were protease inhibitorâbased. At switch, median age was 8.4 years and 50% had a prior AIDS diagnosis. Median followâup after switch to secondâline ranged from 1.8 years in SSA to 5.3 years in North America. Median CD4 counts at switch to secondâline ranged from 235 cells/mm^{3} in SSA to 828 cells/mm^{3} in North America. Improvements in CD4 counts were observed over two years of followâup, particularly in regions with lower CD4 counts at secondâline switch. Improvements in weightâforâage zâscores were not observed during followâup. Cumulative incidence of LTFU at two years was <5% in all regions except SSA (7.1%) and Southern Africa (7.4%). Risk of mortality was <3% at two years of followâup in all regions, except Latin America (4.9%) and SSA (5.5%). CONCLUSIONS: Children switched to secondâline ART experience CD4 count increases as well as low to moderate rates of LTFU and mortality within two years after switch. Severe immune deficiency at time of switch in some settings suggests need for improved recognition and management of treatment failure in children