Alvarez-Uria Gerardo, Naik Praveen Kumar, Midde Manoranjan, Pakam Raghavakalyan
Department of Infectious Diseases, Rural Development Trust Hospital , Bathalapalli, AP, India.
Infect Dis Rep. 2014 May 13;6(2):5167. doi: 10.4081/idr.2014.5167.
Data on attrition due to mortality or loss to follow-up (LTFU) from antiretroviral therapy (ART) eligibility to ART initiation of HIV-infected children are scarce. The aim of this study is to describe attrition before ART initiation of 247 children who were eligible for ART in a cohort study in India. Multivariable analysis was performed using competing risk regression. The cumulative incidence of attrition was 12.6% (95% confidence interval, 8.7-17.3) after five years of follow-up, and the attrition rate was higher during the first months after ART eligibility. Older children (>9 years) had a lower mortality risk before ART initiation than those aged <2 years. Female children had a lower risk of LTFU before ART initiation than males. Children who belonged to scheduled tribes had a higher risk of delayed ART initiation and LTFU. Orphan children had a higher risk of delayed ART initiation and mortality. Children who were >3 months in care before ART eligibility were less likely to be LTFU. The 12-month risk of AIDS, which was calculated using the absolute CD4 cell count and age, was strongly associated with mortality. A substantial proportion of ART-eligible children died or were LTFU before the initiation of ART. These findings can be used in HIV programmes to design actions aimed at reducing the attrition of ART-eligible children in India.
关于感染艾滋病毒儿童从符合抗逆转录病毒疗法（ART）资格到开始接受ART期间因死亡或失访（LTFU）导致的损耗数据很少。本研究的目的是描述在印度一项队列研究中247名符合ART资格的儿童在开始ART之前的损耗情况。使用竞争风险回归进行多变量分析。随访五年后的累计损耗发生率为12.6%（95%置信区间，8.7 - 17.3），且在符合ART资格后的最初几个月损耗率更高。年龄较大的儿童（>9岁）在开始ART之前的死亡风险低于2岁以下儿童。女童在开始ART之前发生LTFU的风险低于男童。属于在册部落的儿童延迟开始ART和发生LTFU的风险更高。孤儿延迟开始ART和死亡的风险更高。在符合ART资格之前接受照料超过3个月的儿童发生LTFU的可能性较小。使用绝对CD4细胞计数和年龄计算的12个月艾滋病风险与死亡率密切相关。相当一部分符合ART资格的儿童在开始ART之前死亡或失访。这些研究结果可用于艾滋病毒项目，以设计旨在减少印度符合ART资格儿童损耗的行动。
