Growth and mortality outcomes for different antiretroviral therapy initiation criteria in children ages 1–5 Years: a causal modeling analysis

 

Show simple item record

dc.contributor.author Schomaker, Michael
dc.contributor.author Davies, Mary-Ann
dc.contributor.author Malateste, Karen
dc.contributor.author Renner, Lorna
dc.contributor.author Sawry, Shobna
dc.contributor.author N’Gbeche, Sylvie
dc.contributor.author Technau, Karl-Günter
dc.contributor.author Eboua, François
dc.contributor.author Tanser, Frank
dc.contributor.author Sygnaté-Sy, Haby
dc.contributor.author Phiri, Sam
dc.contributor.author Madeleine, Amorissani-Folquet
dc.contributor.author Cox, Vivian
dc.contributor.author Koueta, Fla
dc.contributor.author Chimbete, Cleophas
dc.contributor.author Lawson-Evi, Annette
dc.contributor.author Giddy, Janet
dc.contributor.author Amani-Bosse, Clarisse
dc.contributor.author Wood, Robin
dc.contributor.author Egger, Matthias
dc.contributor.author Leroy, Valeriane
dc.date.accessioned 2016-08-15T13:52:10Z
dc.date.available 2016-08-15T13:52:10Z
dc.date.issued 2016
dc.identifier http://dx.doi.org/10.1097/EDE.0000000000000412
dc.identifier.citation Schomaker, M., Davies, M. A., Malateste, K., Renner, L., Sawry, S., N’Gbeche, S., ... & Phiri, S. (2016). Growth and Mortality Outcomes for Different Antiretroviral Therapy Initiation Criteria in Children Ages 1–5 Years: A Causal Modeling Analysis. Epidemiology, 27(2), 237-246. en_ZA
dc.identifier.issn 1044-3983 en_ZA
dc.identifier.uri http://hdl.handle.net/11427/21254
dc.description.abstract Background: There is limited evidence regarding the optimal timing of initiating antiretroviral therapy (ART) in children. We conducted a causal modeling analysis in children ages 1–5 years from the International Epidemiologic Databases to Evaluate AIDS West/Southern-Africa collaboration to determine growth and mortality differences related to different CD4-based treatment initiation criteria, age groups, and regions. Methods: ART-naïve children of ages 12–59 months at enrollment with at least one visit before ART initiation and one follow-up visit were included. We estimated 3-year growth and cumulative mortality from the start of follow-up for different CD4 criteria using g-computation. Results: About one quarter of the 5,826 included children was from West Africa (24.6%).The median (first; third quartile) CD4% at the first visit was 16% (11%; 23%), the median weight-for-age z-scores and height-for-age z-scores were −1.5 (−2.7; −0.6) and −2.5 (−3.5; −1.5), respectively. Estimated cumulative mortality was higher overall, and growth was slower, when initiating ART at lower CD4 thresholds. After 3 years of follow-up, the estimated mortality difference between starting ART routinely irrespective of CD4 count and starting ART if either CD4 count <750 cells/mm3 or CD4% <25% was 0.2% (95% CI = −0.2%; 0.3%), and the difference in the mean height-for-age z-scores of those who survived was −0.02 (95% CI = −0.04; 0.01). Younger children ages 1–2 and children in West Africa had worse outcomes. Conclusions: Our results demonstrate that earlier treatment initiation yields overall better growth and mortality outcomes, although we could not show any differences in outcomes between immediate ART and delaying until CD4 count/% falls below 750/25%. en_ZA
dc.language eng en_ZA
dc.publisher Lippincott, Williams & Wilkins en_ZA
dc.source Epidemiology en_ZA
dc.source.uri http://journals.lww.com/epidem/pages/default.aspx
dc.title Growth and mortality outcomes for different antiretroviral therapy initiation criteria in children ages 1–5 Years: a causal modeling analysis en_ZA
dc.type Journal Article en_ZA
dc.date.updated 2016-08-12T11:29:02Z
uct.type.publication Research en_ZA
uct.type.resource Article en_ZA
dc.publisher.institution University of Cape Town
uct.type.filetype Text
uct.type.filetype Image
dc.identifier.apacitation Schomaker, M., Davies, M., Malateste, K., Renner, L., Sawry, S., , ... Leroy, V. (2016). Growth and mortality outcomes for different antiretroviral therapy initiation criteria in children ages 1–5 Years: a causal modeling analysis. <i>Epidemiology</i>, http://hdl.handle.net/11427/21254 en_ZA
dc.identifier.chicagocitation Schomaker, Michael, Mary-Ann Davies, Karen Malateste, Lorna Renner, Shobna Sawry, , Karl-Günter Technau, et al "Growth and mortality outcomes for different antiretroviral therapy initiation criteria in children ages 1–5 Years: a causal modeling analysis." <i>Epidemiology</i> (2016) http://hdl.handle.net/11427/21254 en_ZA
dc.identifier.vancouvercitation Schomaker M, Davies M, Malateste K, Renner L, Sawry S, , et al. Growth and mortality outcomes for different antiretroviral therapy initiation criteria in children ages 1–5 Years: a causal modeling analysis. Epidemiology. 2016; http://hdl.handle.net/11427/21254. en_ZA
dc.identifier.ris TY - Journal Article AU - Schomaker, Michael AU - Davies, Mary-Ann AU - Malateste, Karen AU - Renner, Lorna AU - Sawry, Shobna AU - N’Gbeche, Sylvie AU - Technau, Karl-Günter AU - Eboua, François AU - Tanser, Frank AU - Sygnaté-Sy, Haby AU - Phiri, Sam AU - Madeleine, Amorissani-Folquet AU - Cox, Vivian AU - Koueta, Fla AU - Chimbete, Cleophas AU - Lawson-Evi, Annette AU - Giddy, Janet AU - Amani-Bosse, Clarisse AU - Wood, Robin AU - Egger, Matthias AU - Leroy, Valeriane AB - Background: There is limited evidence regarding the optimal timing of initiating antiretroviral therapy (ART) in children. We conducted a causal modeling analysis in children ages 1–5 years from the International Epidemiologic Databases to Evaluate AIDS West/Southern-Africa collaboration to determine growth and mortality differences related to different CD4-based treatment initiation criteria, age groups, and regions. Methods: ART-naïve children of ages 12–59 months at enrollment with at least one visit before ART initiation and one follow-up visit were included. We estimated 3-year growth and cumulative mortality from the start of follow-up for different CD4 criteria using g-computation. Results: About one quarter of the 5,826 included children was from West Africa (24.6%).The median (first; third quartile) CD4% at the first visit was 16% (11%; 23%), the median weight-for-age z-scores and height-for-age z-scores were −1.5 (−2.7; −0.6) and −2.5 (−3.5; −1.5), respectively. Estimated cumulative mortality was higher overall, and growth was slower, when initiating ART at lower CD4 thresholds. After 3 years of follow-up, the estimated mortality difference between starting ART routinely irrespective of CD4 count and starting ART if either CD4 count <750 cells/mm3 or CD4% <25% was 0.2% (95% CI = −0.2%; 0.3%), and the difference in the mean height-for-age z-scores of those who survived was −0.02 (95% CI = −0.04; 0.01). Younger children ages 1–2 and children in West Africa had worse outcomes. Conclusions: Our results demonstrate that earlier treatment initiation yields overall better growth and mortality outcomes, although we could not show any differences in outcomes between immediate ART and delaying until CD4 count/% falls below 750/25%. DA - 2016 DB - OpenUCT DP - University of Cape Town J1 - Epidemiology LK - https://open.uct.ac.za PB - University of Cape Town PY - 2016 SM - 1044-3983 T1 - Growth and mortality outcomes for different antiretroviral therapy initiation criteria in children ages 1–5 Years: a causal modeling analysis TI - Growth and mortality outcomes for different antiretroviral therapy initiation criteria in children ages 1–5 Years: a causal modeling analysis UR - http://hdl.handle.net/11427/21254 ER - en_ZA


Files in this item

This item appears in the following Collection(s)

Show simple item record