Teeraananchai Sirinya, Kerr Stephen J, Puthanakit Thanyawee, Bunupuradah Torsak, Ruxrungtham Kiat, Chaivooth Suchada, Law Matthew G, Chokephaibulkit Kulkanya
HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand; Kirby Institute, University of New South Wales, Sydney, Australia.
HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok, Thailand; Kirby Institute, University of New South Wales, Sydney, Australia.
J Pediatr. 2017 Sep;188:210-216.e1. doi: 10.1016/j.jpeds.2017.05.035. Epub 2017 Jun 9.
To assess mortality and loss to follow-up of children with HIV infection who started antiretroviral therapy (ART) through the Universal Coverage Health Program (UC) in Thailand.
Children with HIV infection who initiated ART at age <15 years through the UC between 2008 and 2013 were included in the analysis. Death was ascertained through linkage with the National Death Registry. A competing-risks method was used to calculate subdistribution hazard ratios (SHRs) of predictors for loss to follow-up. Death was considered a competing risk. Cox proportional hazards models were used to assess predictors of mortality.
A total of 4618 children from 497 hospitals in Thailand were included in the study. Median age at ART initiation was 9 years (IQR, 6-12 years), and the median duration of tracking was 4.1 years (a total of 18 817 person-years). Three hundred and ninety-five children (9%) died, for a mortality rate of 2.1 (95% CI, 1.9-2.3) per 100 person-years, and 525 children (11%) were lost to follow-up, for a lost to follow-up rate of 2.9 (95% CI, 2.7-3.2) per 100 person-years. The cumulative incidence of loss to follow-up increased from 4% at 1 year to 8.8% at 3 years. Children who started ART at age ≥12 years were at the greatest risk of loss to follow-up. The probability of death was 3.2% at 6 months and 6.4% at 3 years. Age ≥12 years at ART initiation, lower baseline CD4%, advanced HIV staging, and loss to follow-up were associated with mortality.
The Thai national HIV treatment program has been very effective in treating children with HIV infection, with low mortality and modest rates of loss to follow-up.
评估泰国通过全民覆盖健康计划（UC）开始抗逆转录病毒治疗（ART）的HIV感染儿童的死亡率和失访情况。
纳入2008年至2013年间通过UC在15岁之前开始接受ART的HIV感染儿童进行分析。通过与国家死亡登记处的关联确定死亡情况。采用竞争风险方法计算失访预测因素的亚分布风险比（SHR）。将死亡视为竞争风险。使用Cox比例风险模型评估死亡率的预测因素。
泰国497家医院的4618名儿童纳入研究。开始ART的中位年龄为9岁（四分位间距，6 - 12岁），中位追踪时间为4.1年（总计18817人年）。395名儿童（9%）死亡，死亡率为每100人年2.1（95%CI，1.9 - 2.3），525名儿童（11%）失访，失访率为每100人年2.9（95%CI，2.7 - 3.2）。失访的累积发生率从1年时的4%增加到3年时的8.8%。12岁及以上开始ART的儿童失访风险最高。6个月时死亡概率为3.2%，3年时为6.4%。开始ART时年龄≥12岁、基线CD4%较低、HIV分期较晚和失访与死亡率相关。
泰国国家HIV治疗计划在治疗HIV感染儿童方面非常有效，死亡率低，失访率适中。
