title: Mortality and clinical outcomes in children treated with antiretroviral therapy in four African vertical programmes during the first decade of paediatric HIV care, 2001-2010.
abstract: To assess mortality and clinical outcomes in children treated with antiretroviral therapy (ART) in four African vertical programmes between 2001 and 2010.
  
  
  
  Cohort analysis of data from HIV-infected children (<15 years old) initiating ART in four sub-Saharan HIV programmes in Kenya, Uganda and Malawi, between December 2001 and December 2010. Rates of mortality, programme attrition and first-line clinico-immunological failure were calculated by age group (<2, 2-4 and 5-14 years), 1 or 2 years after ART initiation, and risk factors were examined.
  
  
  
  A total of 3949 children, 22.7% aged <2 years, 32.2% 2-4 years and 45.1% 5-14 years, were included. At ART initiation, 60.8% had clinical stage 3 or 4, and 46.5% severe immunosuppression. Overall mortality, attrition and 1-year failure rates were 5.1, 10.8 and 9.0 per 100 person-years, respectively. Immunosuppression, stage 3 or 4, and underweight were associated with increased rates of mortality, attrition and treatment failure. Adjusted estimates showed lower mortality hazard ratios (HR) among children aged 2-4 years (HR = 0.57, 95% CI 0.42-0.77 than children aged 5-14 years). One-year treatment failure incidence rate ratios (IRR) were similar regardless of age (IRR = 0.91, 95% CI 0.67-1.25 for <2 years; 1.01, 95% CI 0.83-1.23 for 2-4 years, vs. 5-14 years).
  
  
  
  Good treatment outcomes were achieved during the first decade of HIV paediatric care despite the late start of therapy. Encouraging early HIV infant diagnosis in and outside prevention of mother-to-child transmission programmes, and linkage to care services for early ART initiation, is needed to reduce mortality and delay treatment failure.
authors.affiliation: Epicentre, Paris, France.
authors.forename: Jihane
authors.initials: J
authors.lastname: Ben-Farhat
authors.affiliation: Epicentre, Paris, France.
authors.forename: Birgit
authors.initials: B
authors.lastname: Schramm
authors.affiliation: Epicentre, Paris, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Nicolay
authors.affiliation: Médecins Sans Frontières, Nairobi, Kenya.
authors.forename: Stephen
authors.initials: S
authors.lastname: Wanjala
authors.affiliation: Médecins Sans Frontières, Paris, France.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Szumilin
authors.affiliation: Médecins Sans Frontières, Paris, France.
authors.forename: Suna
authors.initials: S
authors.lastname: Balkan
authors.affiliation: Epicentre, Paris, France.|MRC Medical Bioinformatics Centre, University of Leeds, Leeds, UK.
authors.forename: Mar
authors.initials: M
authors.lastname: Pujades-Rodríguez
mesh_terms: D000293:Adolescent; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003695:Delivery of Health Care / Q000592:standards*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D007223:Infant; D007630:Kenya / Q000453:epidemiology; D008295:Malawi / Q000453:epidemiology; D008297:Male; D016896:Treatment Outcome; D014454:Uganda / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents
keywords: 
  HIV
  ; antiretroviral therapy; cohort studies; mortality; paediatrics; treatment failure