title: Impact of antiretroviral therapy on opportunistic infections of HIV-infected children in the therapeutic research, education and AIDS training asia pediatric HIV observational database.
abstract: BACKGROUND
  There are limited data on opportunistic infections (OIs) and factors associated with their occurrence after highly active antiretroviral therapy (HAART) in Asian children. The use of HAART in Asia started much later than in developed countries and therefore reported findings may not be fully applicable to the pediatric HIV epidemic in Asia.
  
  
  METHODS
  Retrospective and prospectively collected data from the Therapeutic Research, Education and AIDS Training Asia Pediatric HIV Observational Database cohort study from March 1993 to March 2009 were analyzed. OIs were defined according to World Health Organization clinical staging criteria and incidence rates calculated. Factors associated with the incidence of severe OIs were analyzed using random effects Poisson regression modeling.
  
  
  RESULTS
  Of 2280 children in the cohort, 1752 were ever reported to have received antiretroviral therapy, of whom 1480 (84%) started on HAART. Before commencing any antiretroviral therapy, OIs occurred at a rate of 89.5 per 100 person-years. The incidence rate was 28.8 infections per 100 person-years during mono- or dual-therapy and 10.5 infections per 100 person-years during HAART. The most common OIs both before and after antiretroviral therapy initiation were recurrent upper respiratory tract infections, persistent oral candidiasis and pulmonary tuberculosis. The incidence rates of World Health Organization clinical stage 3 or 4 OIs after HAART were highest among children <18 months of age and those with low weight-for-age z scores, CD4 cell % <15%, and World Health Organization stage 3 at HAART initiation.
  
  
  CONCLUSIONS
  Despite dramatic declines in their incidence, OIs remained important causes of morbidity after HAART initiation in this regional cohort of HIV-infected children in Asia.
authors.affiliation: From the *Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University; †HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), Thai Red Cross-AIDS Research Centre, Bangkok, Thailand; ‡Biostatistics and Databases Program, The Kirby Institute, Faculty of Medicine, The University of New South Wales, Sydney, Australia; §Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok; ¶Department of Pediatrics, Khon Kaen University, Khon Kaen; ‖Department of Pediatrics, Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand; **Department of Pediatrics, Hospital Likas, Kota Kinabalu, Malaysia; ††YR Gaitonde Centre for AIDS Research and Education, Chennai, India; ‡‡Pediatric Institute, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia; §§Chiang Mai University, Chiang Mai; and ¶¶TREAT Asia/amfAR-The Foundation for AIDS Research, Bangkok, Thailand.
authors.forename: Wasana
authors.initials: W
authors.lastname: Prasitsuebsai
authors.forename: Azar
authors.initials: A
authors.lastname: Kariminia
authors.forename: Thanyawee
authors.initials: T
authors.lastname: Puthanakit
authors.forename: Pagakrong
authors.initials: P
authors.lastname: Lumbiganon
authors.forename: Rawiwan
authors.initials: R
authors.lastname: Hansudewechakul
authors.forename: Fong
authors.initials: F
authors.lastname: Siew Moy
authors.forename: Matthew
authors.initials: M
authors.lastname: Law
authors.forename: Nagalingeswaran
authors.initials: N
authors.lastname: Kumarasamy
authors.forename: Kamarul
authors.initials: K
authors.lastname: Razali
authors.forename: Virat
authors.initials: V
authors.lastname: Sirisanthana
authors.forename: Annette H
authors.initials: AH
authors.lastname: Sohn
authors.forename: Kulkanya
authors.initials: K
authors.lastname: Chokephaibulkit
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology*; D000293:Adolescent; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D001208:Asia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D012189:Retrospective Studies
chemical_list: D044966:Anti-Retroviral Agents