Zeng Xiaoliang, Chen Huanhuan, Zhu Qiuying, Shen Zhiyong, Lan Guanghua, Liang Jiangming, Liang Fuxiong, Zhu Jinhui, Xing Hui, Shao Yiming, Ruan Yuhua, Zhang Jianfeng, Zhang Xiangjun
Guangxi Key Laboratory of Major Infectious Disease Prevention Control and Biosafety Emergency Response, Guangxi Center for Disease Control and Prevention, Nanning, China.
The Second Affiliated Hospital of Guangxi Medical University, Nanning, China.
Front Pediatr. 2022 Jul 12;10:916740. doi: 10.3389/fped.2022.916740. eCollection 2022.
The number of HIV infected children receiving antiviral treatment in Guangxi is increasing. Understanding factors and trends of mortality and attrition in HIV-infected children under antiretroviral therapy (ART) was an urgent need to improve treatment outcomes. This study aimed to estimate mortality and attrition rates and identify factors that were associated with mortality and attrition after ART initiation among children with HIV in Guangxi, China between 2004 and 2018.
Cohort study data were extracted from the National Free Antiretroviral Treatment Program (NFATP) database, which has standard guidelines for core treatment indicators and other data at all HIV/AIDS treatment facilities in Guangxi. A total of 901 HIV-infected children who have started ART were included in the study. The study collected the following data: age, gender, WHO clinic stages before ART, CD4 cell count before ART, Cotrimoxazole prophylaxis (CTX) use before ART, initial ART regimen, malnutrition before ART, abnormal liver function before ART, abnormal kidney function before ART, severe anemia before ART, and the time lag between an HIV diagnosis and ART initiation.
HIV-infected children under ART had a mortality rate of 0.87 per 100 person-years [95% Confidence Interval (CI) 0.63-1.11], and an attrition rate of 3.02 per 100 person-years (95% CI 2.57-3.47). Mortality was lower among children with a CD4 count between 200 and 500 copies/ml [Adjusted Hazard Ratio (AHR) 0.22, 95% CI 0.09-0.55], and CD4 count ≥500 copies/ml (AHR 0.10, 95% CI 0.03-0.29); but higher among children with late ART initiation at 1-3 months (AHR 2.30, 95% CI 1.07-4.94), and at ≥3 months (AHR 2.22, 95% CI 1.04-4.74). Attrition was lower among children with a CD4 count ≥500 copies/ml (AHR 0.62, 95% CI 0.41-0.95), but higher among children with late ART initiation at 1-3 months (AHR 1.55, 95% CI 1.05-2.30).
Supportive programs are needed to educate children's families and parents on early ART, link HIV-infected children to care and retain them in care among other programs that treat and manage the medical conditions of HIV-infected children before ART initiation.
广西接受抗病毒治疗的HIV感染儿童数量不断增加。了解接受抗逆转录病毒治疗（ART）的HIV感染儿童的死亡和失访因素及趋势，对于改善治疗效果迫在眉睫。本研究旨在估算2004年至2018年期间中国广西HIV感染儿童开始ART治疗后的死亡率和失访率，并确定与死亡率和失访相关的因素。
队列研究数据取自国家免费抗逆转录病毒治疗项目（NFATP）数据库，该数据库对广西所有HIV/AIDS治疗机构的核心治疗指标及其他数据有标准指南。共有901名开始ART治疗的HIV感染儿童纳入研究。研究收集了以下数据：年龄、性别、ART治疗前的WHO临床分期、ART治疗前的CD4细胞计数、ART治疗前的复方新诺明预防性用药（CTX）情况、初始ART治疗方案、ART治疗前的营养不良情况、ART治疗前的肝功能异常情况、ART治疗前的肾功能异常情况、ART治疗前的严重贫血情况，以及HIV诊断与ART治疗开始之间的时间间隔。
接受ART治疗的HIV感染儿童的死亡率为每100人年0.87例[95%置信区间（CI）0.63 - 1.11]，失访率为每100人年3.02例（95% CI 2.57 - 3.
