The effect of early initiation of antiretroviral treatment in infants receiving pediatric auto immune deficiency syndrome mortality in South Africa

Johnson, L.F., Davies, M.-A., Moultrie, H., Sherman, G.G., Bland, R.M., Rehle, T.M., Dorrington, R.E. and Newell, M.-L. (2012) The effect of early initiation of antiretroviral treatment in infants receiving pediatric auto immune deficiency syndrome mortality in South Africa. Pediatric Infectious Disease Journal, 31(5), pp. 469-473. (doi: 10.1097/INF.0b013e3182456ba2)

Abstract

<p><b>BACKGROUND:</b> Guidelines for treatment of pediatric HIV have recently changed to recommend that all infants who are identified as HIV-infected should start antiretroviral treatment (ART) immediately, regardless of their immunologic or clinical status. This study aims to assess the likely impact of this change in guideline in South Africa.</p> <p><b>METHODS:</b> A mathematic model was developed to simulate mother-to-child transmission of HIV, disease progression and death of HIV-infected children <15 years of age. The model is calibrated to South African data sources, including prevention of mother-to-child transmission program coverage data, pre-ART survival data, ART program statistics and pediatric HIV prevalence studies.</p> <p><b>RESULTS:</b> Relative to what would be expected in the absence of early ART initiation, the number of infant AIDS deaths over the 2010-2025 period is expected to drop by 23.6% (95% CI: 22.5-24.5%) at current levels of polymerase chain reaction (PCR) diagnosis, and by 34.2% (95% CI: 32.7-35.6%) if PCR diagnosis increases to 80% of perinatally infected infants at 2 months. However, the pediatric HIV disease burden has shifted towards older children in recent years. The effect of early ART on total pediatric AIDS mortality during the 2010-2025 period is therefore modest: a 9.8% reduction (95% CI: 7.9-12.6%) at current levels of PCR diagnosis, and a 14.2% reduction (95% CI: 11.4-18.2%) if PCR coverage increases to 80% of perinatally infected infants.</p> <p><b>CONCLUSION:</b> The changes in ART guidelines for infants will have a significant impact on pediatric AIDS mortality at young ages, but further efforts are required to reduce the substantial growing AIDS mortality in older children.</p>

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Bland, Dr Ruth
• Authors: Johnson, L.F., Davies, M.-A., Moultrie, H., Sherman, G.G., Bland, R.M., Rehle, T.M., Dorrington, R.E., and Newell, M.-L.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Clinical Specialities
• Journal Name: Pediatric Infectious Disease Journal
• ISSN: 0891-3668