title: Long-term outcomes of HIV-infected children in Thailand: the Thailand Pediatric HIV Observational Database.
abstract: OBJECTIVE
  To describe the outcomes of antiretroviral therapy (ART) in a large cohort of HIV-infected children in Thailand.
  
  
  METHODS
  The data were obtained from four collaborative referral sites around the country. Data from 2008 to March 2011 were collected prospectively, and data before 2008 were collected retrospectively.
  
  
  RESULTS
  Of the 1139 children, 599 (52.6%) were female, and the duration of ART was a median 2.9 years (interquartile range (IQR) 3.3-5.5 years). At ART initiation, the median age was 7.1 years (IQR 3.4-10.0 years), CD4 percentage was 9.0% (IQR 3.0-17.0%), and 61.3% were in World Health Organization (WHO) stage 3 or 4. Seventy-four percent were initiated on an NNRTI-based regimen. The death and lost to follow-up rates were 1.3 (95% confidence interval (CI) 1.1-1.6) and 2.2 (95% CI 1.6-2.6)/100 patient-years of follow-up, respectively. At the last clinic visit of 919 children, the median CD4 percentage was 27.0% (IQR 23.0-32.0%) and 80.2% had HIV-RNA <40 copies/ml. WHO stage 1 or 2 at ART initiation was associated with having a viral load <40 copies/ml (p < 0.002), and baseline CD4 ≥15% and starting with a three-drug regimen were associated with achieving CD4 ≥25% (p<0.001).
  
  
  CONCLUSIONS
  Although most children initiated ART at low CD4 levels, the majority achieved immune reconstitution and long-term virological control. Earlier treatment may improve these outcomes.
authors.affiliation: Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Wanatpreeya
authors.initials: W
authors.lastname: Phongsamart
authors.affiliation: Chiangrai Prachanukroh Hospital, Chiangrai, Thailand.
authors.forename: Rawiwan
authors.initials: R
authors.lastname: Hansudewechakul
authors.affiliation: The HIV Netherlands Australia Thailand Research Collaboration, the Thai Red Cross AIDS Research Center, Bangkok, Thailand.
authors.forename: Torsak
authors.initials: T
authors.lastname: Bunupuradah
authors.affiliation: Sanpatong Hospital, Chiangmai, Thailand.
authors.forename: Virat
authors.initials: V
authors.lastname: Klinbuayaem
authors.affiliation: The HIV Netherlands Australia Thailand Research Collaboration, the Thai Red Cross AIDS Research Center, Bangkok, Thailand.
authors.forename: Sirinya
authors.initials: S
authors.lastname: Teeraananchai
authors.affiliation: Bamrasnaradura Infectious Disease Institute, Nonthaburi, Thailand.
authors.forename: Wisit
authors.initials: W
authors.lastname: Prasithsirikul
authors.affiliation: The HIV Netherlands Australia Thailand Research Collaboration, the Thai Red Cross AIDS Research Center, Bangkok, Thailand; Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, Australia.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Kerr
authors.affiliation: Sanpatong Hospital, Chiangmai, Thailand.
authors.forename: Noppadon
authors.initials: N
authors.lastname: Akarathum
authors.affiliation: Chiangrai Prachanukroh Hospital, Chiangrai, Thailand.
authors.forename: Sukanda
authors.initials: S
authors.lastname: Denjunta
authors.affiliation: The HIV Netherlands Australia Thailand Research Collaboration, the Thai Red Cross AIDS Research Center, Bangkok, Thailand; Kirby Institute for Infection and Immunity in Society, University of New South Wales, Sydney, Australia; Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; SEARCH, The Thai Red Cross AIDS Research Center, Bangkok, Thailand.
authors.forename: Jintanat
authors.initials: J
authors.lastname: Ananworanich
authors.affiliation: Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. Electronic address: sikch@mahidol.ac.th.
authors.forename: Kulkanya
authors.initials: K
authors.lastname: Chokephaibulkit
mesh_terms: D000293:Adolescent; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000187:drug effects / Q000473:pathology / Q000821:virology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000821:virology; D015497:HIV-1 / Q000187:drug effects / Q000502:physiology; D006801:Humans; D008297:Male; D016019:Survival Analysis; D013785:Thailand; D016896:Treatment Outcome; D019562:Viral Load
keywords: Antiretroviral therapy; HIV; Long-term outcome; Mortality