title: The effect of highly active antiretroviral therapy on the survival of HIV-infected children in a resource-deprived setting: a cohort study.
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.
  
  
  RESULTS
  Observational data from HAART-naïve 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. Please see later in the article for the Editors' Summary.
authors.affiliation: Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America. aedmonds@email.unc.edu
authors.forename: Andrew
authors.initials: A
authors.lastname: Edmonds
authors.forename: Marcel
authors.initials: M
authors.lastname: Yotebieng
authors.forename: Jean
authors.initials: J
authors.lastname: Lusiama
authors.forename: Yori
authors.initials: Y
authors.lastname: Matumona
authors.forename: Faustin
authors.initials: F
authors.lastname: Kitetele
authors.forename: Sonia
authors.initials: S
authors.lastname: Napravnik
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Cole
authors.forename: Annelies
authors.initials: A
authors.lastname: Van Rie
authors.forename: Frieda
authors.initials: F
authors.lastname: Behets
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003695:Delivery of Health Care; D015023:Democratic Republic of the Congo; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality*; D006801:Humans; D008297:Male; D016896:Treatment Outcome
chemical_list: D019380:Anti-HIV Agents