Short-term risk of HIV disease progression and death in Ugandan children not eligible for antiretroviral therapy.
BACKGROUND
Increasing numbers of HIV-infected children not yet eligible for antiretroviral therapy (ART) are entering health care in Africa. We sought to characterize the risk of short-term disease progression in this population.


METHODS
In a cohort of HIV-infected ART-naive and -ineligible Ugandan children older than 1 year, the rates of clinical/immunologic progression within 2 years were assessed using Kaplan-Meier survival analysis and multivariate Cox proportional-hazards modeling.


RESULTS
Among 192 children (mean age: 6.4 years, CD4%:25), 19% progressed within 2 years by World Health Organization stage 3/4 event (n = 22), death (n = 3), or World Health Organization-defined CD4 threshold for ART initiation (n = 12). Significant univariate predictors were CD4% [hazard ratio (HR) = 2.0 per 10% decrease, P = 0.005], HIV RNA level (HR = 2.4 per log10 increase, P = 0.002), male gender (HR = 2.0, P = 0.04), age < 3 years (HR = 3.7, P = 0.001), CD4 activation (%CD4+ CD38+ HLADR+) (HR = 1.6 per 10% increase, P = 0.05), and CD8 activation (%CD8+ CD38+ HLADR+) (HR = 1.3 per 10% increase, P = 0.05] (HR = 1.3, P = 0.5). In multivariate analysis, CD4% (HR = 2.0, P = 0.034), HIV RNA level (HR = 1.8, P = 0.013), and age < 3 years (HR = 3.0, P = 0.008) were independently predictive. Children with HIV RNA >10 copies per milliliter and CD4% <25 had progression rates of 29% (1 year) and 34% (2 years).


CONCLUSIONS
Even with frequent CD4 monitoring, HIV-infected Ugandan children experienced significant clinical events while ineligible for ART per WHO 2006 guidelines.
Charlebois
Edwin D
ED
School of Medicine, University of California, San Francisco, CA 94105, USA. edwin.charlebois@ucsf.edu
Ruel
Theodore D
TD
Gasasira
Anne F
AF
Achan
Jane
J
Kateera
Frederick
F
Akello
Caroline
C
Cao
Huyen
H
Dorsey
Grant
G
Rosenthal
Philip J
PJ
Ssewanyana
Isaac
I
Kamya
Moses R
MR
Havlir
Diane V
DV
D000349:Africa; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D018414:CD8-Positive T-Lymphocytes / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000276:immunology / Q000401:mortality* / Q000473:pathology* / Q000821:virology; D006801:Humans; D007223:Infant; D008213:Lymphocyte Activation; D008297:Male; D012307:Risk Factors; D014454:Uganda; D019562:Viral Load
D019380:Anti-HIV Agents