title: Outcomes of Infants Starting Antiretroviral Therapy in Southern Africa, 2004-2012.
abstract: BACKGROUND
  There are limited published data on the outcomes of infants starting antiretroviral therapy (ART) in routine care in Southern Africa. This study aimed to examine the baseline characteristics and outcomes of infants initiating ART.
  
  
  METHODS
  We analyzed prospectively collected cohort data from routine ART initiation in infants from 11 cohorts contributing to the International Epidemiologic Database to Evaluate AIDS in Southern Africa. We included ART-naive HIV-infected infants aged <12 months initiating ≥3 antiretroviral drugs between 2004 and 2012. Kaplan-Meier estimates were calculated for mortality, loss to follow-up (LTFU), transfer out, and virological suppression. We used Cox proportional hazard models stratified by cohort to determine baseline characteristics associated with outcomes mortality and virological suppression.
  
  
  RESULTS
  The median (interquartile range) age at ART initiation of 4945 infants was 5.9 months (3.7-8.7) with follow-up of 11.2 months (2.8-20.0). At ART initiation, 77% had WHO clinical stage 3 or 4 disease and 87% were severely immunosuppressed. Three-year mortality probability was 16% and LTFU 29%. Severe immunosuppression, WHO stage 3 or 4, anemia, being severely underweight, and initiation of treatment before 2010 were associated with higher mortality. At 12 months after ART initiation, 17% of infants were severely immunosuppressed and the probability of attaining virological suppression was 56%.
  
  
  CONCLUSIONS
  Most infants initiating ART in Southern Africa had severe disease with high probability of LTFU and mortality on ART. Although the majority of infants remaining in care showed immune recovery and virological suppression, these responses were suboptimal.
authors.affiliation: *School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; †MMed Paeds and Child Health (UNZA), Centre for Infectious Disease Research in Zambia, Lusaka, Zambia; ‡Tygerberg Academic Hospital and Stellenbosch University, Cape Town, South Africa; §Lighthouse Trust Clinic, Lilongwe, Malawi; ‖Red Cross War Memorial Children's Hospital, Cape Town, South Africa; ¶School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa; #Wits Reproductive Health and HIV Institute (Wits RHI), University of the Witwatersrand, Johannesburg, South Africa; **Empilweni Services and Research Unit, Department of Paediatrics and Child Health, Rahima Moosa Mother and Child Hospital and University of the Witwatersrand, Johannesburg, South Africa; ††Médecins Sans Frontierès, Khayelitsha and School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; ‡‡Gugulethu Community Health Centre and Desmond Tutu HIV Centre, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa; §§Newlands Clinic, Harare, Zimbabwe; ‖‖Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland; ¶¶McCord Hospital, Durban, South Africa; and ##Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa.
authors.forename: Mireille
authors.initials: M
authors.lastname: Porter
authors.forename: Mary-Ann
authors.initials: MA
authors.lastname: Davies
authors.forename: Muntanga K
authors.initials: MK
authors.lastname: Mapani
authors.forename: Helena
authors.initials: H
authors.lastname: Rabie
authors.forename: Sam
authors.initials: S
authors.lastname: Phiri
authors.forename: James
authors.initials: J
authors.lastname: Nuttall
authors.forename: Lee
authors.initials: L
authors.lastname: Fairlie
authors.forename: Karl-Günter
authors.initials: KG
authors.lastname: Technau
authors.forename: Kathryn
authors.initials: K
authors.lastname: Stinson
authors.forename: Robin
authors.initials: R
authors.lastname: Wood
authors.forename: Maureen
authors.initials: M
authors.lastname: Wellington
authors.forename: Andreas D
authors.initials: AD
authors.lastname: Haas
authors.forename: Janet
authors.initials: J
authors.lastname: Giddy
authors.forename: Frank
authors.initials: F
authors.lastname: Tanser
authors.forename: Brian
authors.initials: B
authors.lastname: Eley
mesh_terms: D000353:Africa, Southern / Q000453:epidemiology; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D007165:Immunosuppression Therapy; D007223:Infant; D008297:Male; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D016896:Treatment Outcome; D019562:Viral Load; D014944:World Health Organization
chemical_list: D019380:Anti-HIV Agents