ABSTRACT
Objectives: To assess the survival probability and associatedfactors among children living with human immunodeficiency virus(CLHIV) receiving antiretroviral therapy (ART) in India.Methods: The data on 5874 children (55% boys) from one of thehigh HIV burden states of India from the cohort were analyzed.Data were extracted from the computerized managementinformation system of the National AIDS Control Organization(NACO). Children were eligible for inclusion if they had startedART during 2007-2013, and had at least one potential follow-up.Kaplan Meier survival and Cox proportional hazards models wereused to measure survival probability.Results: The baseline median (IQR) CD4 count at the start ofantiretroviral therapy was 244 (153, 398). Overall, the mortalitywas 30 per 1000 child years; 39 in the <5 year age group and 25 in5-9 year age group. Mortality was highest among infants (86 per1000 child years). Those with CD4 count ?200 were six timesmore likely to die (adjusted HR: 6.3, 95% CI 3.5, 11.4) ascompared to those with a CD4 count of ?350/mm3.Conclusion: Mortality rates among CLHIV is significantly higheramong children less than five years when the CD4 count at thestart of ART is above 200. Additionally, lower CD4 count, HIVclinical staging IV, and lack of functional status seems to beassociated with high mortality in children who are on ART
ABSTRACT
OBJECTIVES: The survival outcomes of antiretroviral treatment (ART) programs have not been systematically evaluated at the state level in India. This retrospective study assessed the survival rates and factors associated with survival among adult human immunodeficiency virus (HIV)-infected patients in Andhra Pradesh, India. METHODS: The present study used data from 139 679 HIV patients aged ≥15 years on ART who were registered from 2007 to 2011 and were followed up through December 2013. The primary end point was death of the patient. Mortality densities (per 1000 person-years) were calculated. Kaplan-Meier and Cox-regression models were used to estimate survival and explore the factors associated with survival. RESULTS: The overall median follow-up time was 16.0 months (2.0 months for the deceased and 14.0 months for those lost to follow-up). Approximately 13.2% of those newly initiated on ART died during follow-up. Of those deaths, 56% occurred in the first three months. The crude mortality rate was 80.9 per 1000 person-years at risk. The CD4 count (adjusted hazard ratio [aHR],4.88; 95% confidence interval [CI], 4.36 to 5.46 for 350 cells/mm³), functional status (aHR, 3.05; 95% CI, 2.82 to 3.30 for bedridden vs. normal), and body weight (aHR, 3.69; 95% CI, 3.42 to 3.97 for 60 kg) were strongly associated with the survival of HIV patients. CONCLUSIONS: The study findings revealed that high mortality was observed within the first three months of ART initiation. Patients with poor baseline clinical characteristics had a higher risk of mortality. Expanded testing and counseling should be encouraged, with the goal of ensuring early enrollment into the program followed by the initiation of ART in HIV-infected patients.