Early severe HIV disease precedes early antiretroviral therapy in infants : are we too late?
Date
2014-06
Journal Title
Journal ISSN
Volume Title
Publisher
International AIDS Society
Abstract
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% B25% or
absolute CD4B1500 cells/mm3 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 (pB0.0001). In Cape Town, 73 infants (83%) had advanced
HIV disease at ART initiation, compared to 177 infants (56%) in Soweto (pB0.0001). 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.
Description
CITATION: Innes, S. et al. 2014. Early severe HIV disease precedes early antiretroviral therapy in infants: Are we too late? Journal of the International AIDS Society, 17:18914, doi:10.7448/IAS.17.1.18914.
The original publication is available at http://www.jiasociety.org
Publication of this article was funded by the Stellenbosch University Open Access Fund.
The original publication is available at http://www.jiasociety.org
Publication of this article was funded by the Stellenbosch University Open Access Fund.
Keywords
AIDS (Disease) in infants -- Treatment -- South Africa
Citation
Innes, S. et al. 2014. Early severe HIV disease precedes early antiretroviral therapy in infants: Are we too late? Journal of the International AIDS Society, 17:18914, doi:10.7448/IAS.17.1.18914.