title: Mortality in Children with Human Immunodeficiency Virus Initiating Treatment: A Six-Cohort Study in Latin America.
abstract: To assess the risks of and factors associated with mortality, loss to follow-up, and changing regimens after children with HIV infected perinatally initiate combination antiretroviral therapy (cART) in Latin America and the Caribbean.
  
  
  
  This 1997-2013 retrospective cohort study included 1174 antiretroviral therapy-naïve, perinatally infected children who started cART age when they were younger than 18 years of age (median 4.7 years; IQR 1.7-8.8) at 1 of 6 cohorts from Argentina, Brazil, Haiti, and Honduras, within the Caribbean, Central and South America Network for HIV Epidemiology. Median follow-up was 5.6 years (IQR 2.3-9.3). Study outcomes were all-cause mortality, loss to follow-up, and major changes in cART. We used Cox proportional hazards models stratified by site to examine the association between predictors and times to death or changing regimens.
  
  
  
  Only 52% started cART at younger than 5 years of age; 19% began a protease inhibitor. At cART initiation, median CD4 count was 472 cells/mm3(IQR 201-902); median CD4% was 16% (IQR 10-23). Probability of death was high in the first year of cART: 0.06 (95% CI 0.04-0.07). Five years after cART initiation, the cumulative mortality incidence was 0.12 (95% CI 0.10-0.14). Cumulative incidences for loss to follow-up and regimen change after 5 years were 0.16 (95% 0.14-0.18) and 0.30 (95% 0.26-0.34), respectively. Younger children had the greatest risk of mortality, whereas older children had the greatest risk of being lost to follow-up or changing regimens.
  
  
  
  Innovative clinical and community approaches are needed for quality improvement in the pediatric care of HIV in the Americas.
authors.affiliation: Department of Pediatrics, Social Security Honduran Institute, Tegucigalpa, Honduras.
authors.forename: Marco T
authors.initials: MT
authors.lastname: Luque
authors.affiliation: Departments of Biostatistics, Medicine, and Pediatrics, Vanderbilt University School of Medicine, and Vanderbilt Institute for Global Health, Nashville, TN.
authors.forename: Cathy A
authors.initials: CA
authors.lastname: Jenkins
authors.affiliation: Departments of Biostatistics, Medicine, and Pediatrics, Vanderbilt University School of Medicine, and Vanderbilt Institute for Global Health, Nashville, TN.
authors.forename: Bryan E
authors.initials: BE
authors.lastname: Shepherd
authors.affiliation: Department of Pediatrics, Social Security Honduran Institute, Tegucigalpa, Honduras.
authors.forename: Denis
authors.initials: D
authors.lastname: Padgett
authors.affiliation: Haitian Group for Studies of Kaposi Sarcoma and Opportunistic Infections, Port-au-Prince, Haiti.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Rouzier
authors.affiliation: Department of Pediatrics, School of Medicine, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Regina Célia M
authors.initials: RCM
authors.lastname: Succi
authors.affiliation: Department of Pediatrics, School of Medicine, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Daisy M
authors.initials: DM
authors.lastname: Machado
authors.affiliation: Departments of Biostatistics, Medicine, and Pediatrics, Vanderbilt University School of Medicine, and Vanderbilt Institute for Global Health, Nashville, TN.
authors.forename: Catherine C
authors.initials: CC
authors.lastname: McGowan
authors.affiliation: Departments of Biostatistics, Medicine, and Pediatrics, Vanderbilt University School of Medicine, and Vanderbilt Institute for Global Health, Nashville, TN.
authors.forename: Sten H
authors.initials: SH
authors.lastname: Vermund
authors.affiliation: Department of Pediatrics, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil. Electronic address: jpinto@medicina.ufmg.br.
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Pinto
mesh_terms: D000293:Adolescent; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000009:adverse effects; D023241:Antiretroviral Therapy, Highly Active; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016001:Confidence Intervals; D016208:Databases, Factual; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality*; D006801:Humans; D015994:Incidence; D007843:Latin America; D008297:Male; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis
chemical_list: D019380:Anti-HIV Agents
keywords: HIV/AIDS; infectious diseases