title: Outcomes of antiretroviral therapy in children in Asia and Africa: a comparative analysis of the IeDEA pediatric multiregional collaboration.
abstract: BACKGROUND
  We investigated 18-month incidence and determinants of death and loss to follow-up of children after antiretroviral therapy (ART) initiation in a multiregional collaboration in lower-income countries.
  
  
  METHODS
  HIV-infected children (positive polymerase chain reaction <18 months or positive serology ≥18 months) from International Epidemiologic Databases to Evaluate AIDS cohorts, <16 years, initiating ART were eligible. A competing risk regression model was used to analyze the independent risk of 2 failure types: death and loss to follow-up (>6 months).
  
  
  RESULTS
  Data on 13,611 children, from Asia (N = 1454), East Africa (N = 3114), Southern Africa (N = 6212), and West Africa (N = 2881) contributed 20,417 person-years of follow-up. At 18 months, the adjusted risk of death was 4.3% in East Africa, 5.4% in Asia, 5.7% in Southern Africa, and 7.4% in West Africa (P = 0.01). Age < 24 months, World Health Organization stage 4, CD4 < 10%, attending a private sector clinic, larger cohort size, and living in West Africa were independently associated with poorer survival. The adjusted risk of loss to follow-up was 4.1% in Asia, 9.0% in Southern Africa, 14.0% in East Africa, and 21.8% in West Africa (P < 0.01). Age < 12 months, nonnucleoside reverse transcriptase inhibitor I-based ART regimen, World Health Organization stage 4 at ART start, ART initiation after 2005, attending a public sector or a nonurban clinic, having to pay for laboratory tests or antiretroviral drugs, larger cohort size, and living in East Africa or West Africa were significantly associated with higher loss to follow-up.
  
  
  CONCLUSIONS
  Findings differed substantially across regions but raise overall concerns about delayed ART start, low access to free HIV services for children, and increased workload on program retention in lower-income countries. Universal free access to ART services and innovative approaches are urgently needed to improve pediatric outcomes at the program level.
authors.affiliation: Inserm, U897, Epidemiologie-Biostatistiques-Bordeaux, France. valeriane.leroy@isped.u-bordeaux2.fr
authors.forename: Valeriane
authors.initials: V
authors.lastname: Leroy
authors.forename: Karen
authors.initials: K
authors.lastname: Malateste
authors.forename: Helena
authors.initials: H
authors.lastname: Rabie
authors.forename: Pagakrong
authors.initials: P
authors.lastname: Lumbiganon
authors.forename: Samuel
authors.initials: S
authors.lastname: Ayaya
authors.forename: Fatoumata
authors.initials: F
authors.lastname: Dicko
authors.forename: Mary-Ann
authors.initials: MA
authors.lastname: Davies
authors.forename: Azar
authors.initials: A
authors.lastname: Kariminia
authors.forename: Kara
authors.initials: K
authors.lastname: Wools-Kaloustian
authors.forename: Edmond
authors.initials: E
authors.lastname: Aka
authors.forename: Samuel
authors.initials: S
authors.lastname: Phiri
authors.forename: Linda
authors.initials: L
authors.lastname: Aurpibul
authors.forename: Constantin
authors.initials: C
authors.lastname: Yiannoutsos
authors.forename: Haby
authors.initials: H
authors.lastname: Signaté-Sy
authors.forename: Lynne
authors.initials: L
authors.lastname: Mofenson
authors.forename: François
authors.initials: F
authors.lastname: Dabis
mesh_terms: D000293:Adolescent; D000351:Africa, Eastern / Q000453:epidemiology; D000353:Africa, Southern / Q000453:epidemiology; D000354:Africa, Western / Q000453:epidemiology; D000367:Age Factors; D044966:Anti-Retroviral Agents / Q000191:economics / Q000627:therapeutic use*; D001208:Asia / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003906:Developing Countries; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality*; D017320:HIV Protease Inhibitors / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D007391:International Cooperation; D059012:Lost to Follow-Up; D008297:Male; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric
chemical_list: D044966:Anti-Retroviral Agents; D017320:HIV Protease Inhibitors; D018894:Reverse Transcriptase Inhibitors