title: 12-month mortality and loss-to-program in antiretroviral-treated children: The IeDEA pediatric West African Database to evaluate AIDS (pWADA), 2000-2008.
abstract: BACKGROUND
  The IeDEA West Africa Pediatric Working Group (pWADA) was established in January 2007 to study the care and treatment of HIV-infected children in this region. We describe here the characteristics at antiretroviral treatment (ART) initiation and study the 12-month mortality and loss-to-program of HIV-infected children followed in ART programs in West Africa.
  
  
  METHODS
  Standardized data from HIV-infected children followed-up in ART programs were included. Nine clinical centers from six countries contributed to the dataset (Benin, Côte d'Ivoire, Gambia, Ghana, Mali and Senegal). Inclusion criteria were the followings: age 0-15 years and initiated triple antiretroviral drug regimens. Baseline time was the date of ART initiation. WHO criteria was used to define severe immunosuppression based on CD4 count by age or CD4 percent < 15%. We estimated the 12-month Kaplan-Meier probabilities of mortality and loss-to-program (death or loss to follow-up > 6 months) after ART initiation and factors associated with these two outcomes.
  
  
  RESULTS
  Between June 2000 and December 2007, 2170 children were included. Characteristics at ART initiation were the following: median age of 5 years (Interquartile range (IQR: 2-9) and median CD4 percentage of 13% (IQR: 7-19). The most frequent drug regimen consisted of two nucleoside reverse transcriptase inhibitors and one non-nucleoside reverse transcriptase inhibitors (62%). During the first 12 months, 169 (7.8%) children died and 461(21.2%) were lost-to-program. Overall, in HIV-infected children on ART, the 12-month probability of death was 8.3% (95% Confidence Interval (CI): 7.2-9.6%), and of loss-to-program was 23.1% (95% CI: 21.3-25.0%). Both mortality and loss-to program were associated with advanced clinical stage, CD4 percentage < 15% at ART initiation and year (> 2005) of ART initiation.
  
  
  CONCLUSIONS
  Innovative and sustainable approaches are needed to better document causes of death and increase retention in HIV pediatric clinics in West Africa.
authors: INSERM, U897, & Institut de Santé Publique, Epidémiologie et Développement, Université Victor Segalen Bordeaux 2, Bordeaux, France. didier.ekouevi@gmail.com
authors: Didier K
authors: DK
authors: Ekouevi
authors: Alain
authors: A
authors: Azondekon
authors: Fatoumata
authors: F
authors: Dicko
authors: Karen
authors: K
authors: Malateste
authors: Pety
authors: P
authors: Touré
authors: François T
authors: FT
authors: Eboua
authors: Kouakou
authors: K
authors: Kouadio
authors: Lorna
authors: L
authors: Renner
authors: Kevin
authors: K
authors: Peterson
authors: François
authors: F
authors: Dabis
authors: Haby Signaté
authors: HS
authors: Sy
authors: Valeriane
authors: V
authors: Leroy
mesh_terms: D000293:Adolescent; D000354:Africa, Western / Q000453:epidemiology; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D006801:Humans; D007223:Infant; D008297:Male; D009026:Mortality / Q000639:trends*; D010352:Patient Dropouts / Q000706:statistics & numerical data
chemical_list: D018501:Antirheumatic Agents