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

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dc.contributor.authorSchomaker, Michael
dc.contributor.authorDavies, Mary-Ann
dc.contributor.authorMalateste, Karen
dc.contributor.authorRenner, Lorna
dc.contributor.authorSawry, Shobna
dc.contributor.authorN’Gbeche, Sylvie
dc.contributor.authorTechnau, Karl-Günter
dc.contributor.authorEboua, François
dc.contributor.authorTanser, Frank
dc.contributor.authorSygnaté-Sy, Haby
dc.contributor.authorPhiri, Sam
dc.contributor.authorMadeleine, Amorissani-Folquet
dc.contributor.authorCox, Vivian
dc.contributor.authorKoueta, Fla
dc.contributor.authorChimbete, Cleophas
dc.contributor.authorLawson-Evi, Annette
dc.contributor.authorGiddy, Janet
dc.contributor.authorAmani-Bosse, Clarisse
dc.contributor.authorWood, Robin
dc.contributor.authorEgger, Matthias
dc.contributor.authorLeroy, Valeriane
dc.date.accessioned2016-08-15T13:52:10Z
dc.date.available2016-08-15T13:52:10Z
dc.date.issued2016
dc.date.updated2016-08-12T11:29:02Z
dc.description.abstractBackground: 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.identifierhttp://dx.doi.org/10.1097/EDE.0000000000000412
dc.identifier.apacitationSchomaker, 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/11427/21254en_ZA
dc.identifier.chicagocitationSchomaker, 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/11427/21254en_ZA
dc.identifier.citationSchomaker, 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.issn1044-3983en_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
dc.identifier.urihttp://hdl.handle.net/11427/21254
dc.identifier.vancouvercitationSchomaker 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.languageengen_ZA
dc.publisherLippincott, Williams & Wilkinsen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.sourceEpidemiologyen_ZA
dc.source.urihttp://journals.lww.com/epidem/pages/default.aspx
dc.titleGrowth and mortality outcomes for different antiretroviral therapy initiation criteria in children ages 1–5 Years: a causal modeling analysisen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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