title: Mortality and treatment outcomes of China's National Pediatric antiretroviral therapy program.
abstract: BACKGROUND
  The aim of this study was to describe 3-year mortality rates, associated risk factors, and long-term clinical outcomes of children enrolled in China's national free pediatric antiretroviral therapy (ART) program.
  
  
  METHODS
  Records were abstracted from the national human immunodeficiency virus (HIV)/AIDS case reporting and national pediatric ART databases for all HIV-positive children ≤15 years old who initiated ART prior to December 2010. Mortality risk factors over 3 years of follow-up were examined using Cox proportional hazards regression models. Life tables were used to determine survival rate over time. Longitudinal plots of CD4(+) T-cell percentage (CD4%), hemoglobin level, weight-for-age z (WAZ) score, and height-for-age z (HAZ) score were created using generalized estimating equation models.
  
  
  RESULTS
  Among the 1818 children included in our cohort, 93 deaths were recorded in 4022 child-years (CY) of observed time for an overall mortality rate of 2.31 per 100 CY (95% confidence interval [CI], 1.75-2.78). The strongest factor associated with mortality was baseline WAZ score <-2 (adjusted hazard ratio [HR] = 9.1; 95% CI, 2.5-33.2), followed by World Health Organization stage III or IV disease (adjusted HR = 2.4; 95% CI, 1.1-5.2), and hemoglobin <90 g/L (adjusted HR = 2.2; 95% CI, 1.2-3.9). CD4%, hemoglobin level, WAZ score, and HAZ score increased over time.
  
  
  CONCLUSIONS
  Our finding that 94% of children engaged in this program are still alive and of improved health after 3 years of treatment demonstrates that China's national pediatric ART program is effective. This program needs to be expanded to better meet treatment demands, and efforts to identify HIV-positive children earlier must be prioritized.
authors.affiliation: National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, PR China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhao
authors.forename: Chunming
authors.initials: C
authors.lastname: Li
authors.forename: Xin
authors.initials: X
authors.lastname: Sun
authors.forename: Weiwei
authors.initials: W
authors.lastname: Mu
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: McGoogan
authors.forename: Yun
authors.initials: Y
authors.lastname: He
authors.forename: Yuewu
authors.initials: Y
authors.lastname: Cheng
authors.forename: Zhirong
authors.initials: Z
authors.lastname: Tang
authors.forename: Huiqin
authors.initials: H
authors.lastname: Li
authors.forename: Mingjian
authors.initials: M
authors.lastname: Ni
authors.forename: Ye
authors.initials: Y
authors.lastname: Ma
authors.forename: Ray Y
authors.initials: RY
authors.lastname: Chen
authors.forename: Zhongfu
authors.initials: Z
authors.lastname: Liu
authors.forename: Fujie
authors.initials: F
authors.lastname: Zhang
mesh_terms: D000293:Adolescent; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D002681:China; D015331:Cohort Studies; D015658:HIV Infections / Q000188:drug therapy / Q000401:mortality*; D006801:Humans; D007223:Infant; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D019380:Anti-HIV Agents