ABSTRACT
OBJECTIVE: To assess hospitalization trends in HIV-infected children on antiretroviral therapy (ART) in Thailand, an important indicator of morbidity, ART effectiveness, and health service utilization. DESIGN: Prospective observational cohort METHOD: Children initiating ART in 1999-2009 were followed in 40 public hospitals. Hospitalization rate per 100 person-years were calculated from ART initiation to last follow-up/death. Costs to the healthcare provider were calculated using WHO inpatient estimates for Thailand. Zero-inflated Poisson models were used to examine risk factors for early (<12 months of ART) and late hospitalization (≥12 months) and frequency of admissions. RESULTS: A total of 578 children initiated ART, median follow-up being 64 months [interquartile range (IQR) 43-82]; 211 (37%) children were hospitalized with 451 admissions. Hospitalization rates declined from 63 per 100 person-years at less than 6 months to approximately 10 per 100 person-years after 2 years of ART, and costs fell from $35 per patient-month to under $5, respectively. Age less than 2 years, US Centers of Disease Control and Prevention stage B/C, and stunting at ART initiation were associated with early hospitalization. Among those hospitalized, baseline CD4 cell percentage less than 5%, wasting, initiation on dual therapy, late calendar year, and female sex were associated with higher incidence of early admissions (P <0.02). There were no predictors of late hospitalization, although previous hospitalization in less than 12 months of ART was associated with three times higher incidence of late admissions (P < 0.0001). CONCLUSION: One in three children required hospitalization after ART. Admissions were highest in the first year of therapy and rapidly declined thereafter. Young age, advanced disease stage, and stunting at baseline were predictive of early hospitalization. Treatment initiation before disease progression would likely reduce hospitalization and alleviate demands on healthcare services.
Subject(s)
AIDS-Related Opportunistic Infections/epidemiology , Cardiovascular Diseases/epidemiology , Drug-Related Side Effects and Adverse Reactions/epidemiology , HIV Seropositivity/epidemiology , HIV-1 , Hospital Costs/trends , Hospitalization/trends , AIDS-Related Opportunistic Infections/drug therapy , AIDS-Related Opportunistic Infections/economics , Anti-HIV Agents/administration & dosage , Anti-HIV Agents/economics , Body Weight , CD4 Lymphocyte Count , Cardiovascular Diseases/drug therapy , Cardiovascular Diseases/economics , Child , Child, Preschool , Drug-Related Side Effects and Adverse Reactions/drug therapy , Drug-Related Side Effects and Adverse Reactions/economics , Female , Follow-Up Studies , HIV Seropositivity/drug therapy , HIV Seropositivity/economics , Hospital Costs/statistics & numerical data , Hospitalization/economics , Hospitalization/statistics & numerical data , Humans , Infant , Infant, Newborn , Male , Prospective Studies , Risk Factors , Thailand/epidemiology , Viral LoadABSTRACT
Mother-to-child transmission (MTCT) of HIV-1 provides a model for studying the role of passively acquired antibodies in preventing HIV infection. We determined the titers of neutralizing antibodies (NAbs) against six primary isolates of clades B and CRF01_AE in sera from 45 transmitting and 45 nontransmitting mothers matched for the main independent factors associated with MTCT in Thailand. A lower risk of MTCT, particularly for intrapartum transmission, was associated only with higher NAb titers against the CRF01_AE strain, MBA. The envelope glycoprotein of this strain showed an unusually long V2 domain of 63 amino acids, encoding six potential N-linked glycosylation sites. We provided experimental data indicating that the extended V2 domain contributed to the higher level of resistance to neutralization by mothers' sera in this strain. Taken together the data suggest that some primary isolates with specific properties may be useful indicators for identifying protective antibodies.
