Survival of Children Living with Human Immunodeficiency Virus on Antiretroviral Therapy in Andhra Pradesh, India.

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