The changing characteristics of a cohort of children and adolescents living with HIV at antiretroviral therapy initiation in Asia
Despite improvements in HIV testing and earlier antiretroviral therapy (ART) initiation in children living with HIV through the years, a considerable proportion start treatment with advanced disease. We studied characteristics of children and adolescents living with HIV and their level of immunodefi...
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| Veröffentlicht in: | PloS one 2023-09, Vol.18 (9), p.e0291523 |
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| creator | Sornillo, Johanna Beulah Ditangco, Rossana Kinikar, Aarti Wati, Dewi Kumara Du, Quy Tuan Nguyen, Dinh Qui Khol, Vohith Nguyen, Lam Van Puthanakit, Thanyawee Ounchanum, Pradthana Kurniati, Nia Chokephaibulkit, Kulkanya Jamal Mohamed, Thahira A Sudjaritruk, Tavitiya Fong, Siew Moy Kumarasamy, Nagalingeswaran Kosalaraksa, Pope Nallusamy, Revathy A Nik Yusoff, Nik Khairulddin Sohn, Annette H Kariminia, Azar |
| description | Despite improvements in HIV testing and earlier antiretroviral therapy (ART) initiation in children living with HIV through the years, a considerable proportion start treatment with advanced disease. We studied characteristics of children and adolescents living with HIV and their level of immunodeficiency at ART initiation using data from a multi-country Asian cohort. We included children and adolescents who were ART-naïve and |
| doi_str_mv | 10.1371/journal.pone.0291523 |
| format | Article |
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We studied characteristics of children and adolescents living with HIV and their level of immunodeficiency at ART initiation using data from a multi-country Asian cohort. We included children and adolescents who were ART-naïve and <18 years of age at ART initiation from 2011 to 2020 at 17 HIV clinics in six countries. Incidence rates of opportunistic infections (OIs) in the first two years of triple-drug ART (≥3 antiretrovirals) was also reported. Competing risk regression analysis was performed to identify factors associated with first occurrence of OI. In 2,027 children and adolescents (54% males), median age at ART initiation increased from 4.5 years in 2011-2013 to 6.7 in 2017-2020, median CD4 count doubled from 237 cells/μl to 466 cells/μl, and proportion of children who initiated ART as severely immunodeficient decreased from 70% to 45%. During follow-up, 275 (14%) children who received triple-drug ART as first treatment and had at least one clinic visit, developed at least one OI in the first two years of treatment (9.40 per 100 person-years). The incidence rate of any first OI declined from 12.52 to 7.58 per 100 person-years during 2011-2013 and 2017-2020. Lower hazard of OIs were found in those with age at first ART 2-14 years, current CD4 ≥200 cells/μl, and receiving ART between 2017 and 2020. The analysis demonstrated increasing number of children and adolescents starting ART with high CD4 count at ART start. The rate of first OI markedly decreased in children who started ART in more recent years. There remains a clear need for improvement in HIV control strategies in children, by promoting earlier diagnosis and timely treatment.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0291523</identifier><identifier>PMID: 37708128</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Acquired immune deficiency syndrome ; Adolescent ; Adolescents ; Age ; AIDS ; Ambulatory Care ; Analysis ; Anti-Retroviral Agents - therapeutic use ; Antiretroviral agents ; Antiretroviral drugs ; Antiretroviral therapy ; Antiviral agents ; Asia - epidemiology ; Biology and Life Sciences ; CD4 antigen ; Child ; Child, Preschool ; Children ; Drug therapy ; Evidence-based medicine ; Female ; Health aspects ; Highly active antiretroviral therapy ; HIV ; HIV (Viruses) ; HIV infection in children ; HIV Infections - drug therapy ; HIV Infections - epidemiology ; HIV patients ; HIV testing ; Human immunodeficiency virus ; Humans ; Immune system ; Immunodeficiency ; Male ; Medical diagnosis ; Medical records ; Medical research ; Medicine and Health Sciences ; Medicine, Experimental ; Missing data ; Opportunistic Infections ; Patient outcomes ; Patients ; Pediatrics ; People and Places ; Regression analysis ; Risk analysis ; Risk factors ; Statistics ; Teenagers</subject><ispartof>PloS one, 2023-09, Vol.18 (9), p.e0291523</ispartof><rights>Copyright: © 2023 Sornillo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</rights><rights>COPYRIGHT 2023 Public Library of Science</rights><rights>2023 Sornillo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2023 Sornillo et al 2023 Sornillo et al</rights><rights>2023 Sornillo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c642t-cdb5c3c483947e5f74c49f9e8d7b24c331b170b8d33959940b26820e4b81aeb13</cites><orcidid>0000-0002-6380-6672 ; 0000-0002-3686-4623 ; 0000-0001-8331-0845 ; 0000-0002-6572-3694</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10501581/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10501581/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79569,79570</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37708128$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sornillo, Johanna Beulah</creatorcontrib><creatorcontrib>Ditangco, Rossana</creatorcontrib><creatorcontrib>Kinikar, Aarti</creatorcontrib><creatorcontrib>Wati, Dewi Kumara</creatorcontrib><creatorcontrib>Du, Quy Tuan</creatorcontrib><creatorcontrib>Nguyen, Dinh Qui</creatorcontrib><creatorcontrib>Khol, Vohith</creatorcontrib><creatorcontrib>Nguyen, Lam Van</creatorcontrib><creatorcontrib>Puthanakit, Thanyawee</creatorcontrib><creatorcontrib>Ounchanum, Pradthana</creatorcontrib><creatorcontrib>Kurniati, Nia</creatorcontrib><creatorcontrib>Chokephaibulkit, Kulkanya</creatorcontrib><creatorcontrib>Jamal Mohamed, Thahira A</creatorcontrib><creatorcontrib>Sudjaritruk, Tavitiya</creatorcontrib><creatorcontrib>Fong, Siew Moy</creatorcontrib><creatorcontrib>Kumarasamy, Nagalingeswaran</creatorcontrib><creatorcontrib>Kosalaraksa, Pope</creatorcontrib><creatorcontrib>Nallusamy, Revathy A</creatorcontrib><creatorcontrib>Nik Yusoff, Nik Khairulddin</creatorcontrib><creatorcontrib>Sohn, Annette H</creatorcontrib><creatorcontrib>Kariminia, Azar</creatorcontrib><creatorcontrib>TREAT Asia Pediatric HIV Observational Database of IeDEA Asia-Pacific</creatorcontrib><creatorcontrib>on behalf of the TREAT Asia Pediatric HIV Observational Database of IeDEA Asia-Pacific</creatorcontrib><title>The changing characteristics of a cohort of children and adolescents living with HIV at antiretroviral therapy initiation in Asia</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Despite improvements in HIV testing and earlier antiretroviral therapy (ART) initiation in children living with HIV through the years, a considerable proportion start treatment with advanced disease. We studied characteristics of children and adolescents living with HIV and their level of immunodeficiency at ART initiation using data from a multi-country Asian cohort. We included children and adolescents who were ART-naïve and <18 years of age at ART initiation from 2011 to 2020 at 17 HIV clinics in six countries. Incidence rates of opportunistic infections (OIs) in the first two years of triple-drug ART (≥3 antiretrovirals) was also reported. Competing risk regression analysis was performed to identify factors associated with first occurrence of OI. In 2,027 children and adolescents (54% males), median age at ART initiation increased from 4.5 years in 2011-2013 to 6.7 in 2017-2020, median CD4 count doubled from 237 cells/μl to 466 cells/μl, and proportion of children who initiated ART as severely immunodeficient decreased from 70% to 45%. During follow-up, 275 (14%) children who received triple-drug ART as first treatment and had at least one clinic visit, developed at least one OI in the first two years of treatment (9.40 per 100 person-years). The incidence rate of any first OI declined from 12.52 to 7.58 per 100 person-years during 2011-2013 and 2017-2020. Lower hazard of OIs were found in those with age at first ART 2-14 years, current CD4 ≥200 cells/μl, and receiving ART between 2017 and 2020. The analysis demonstrated increasing number of children and adolescents starting ART with high CD4 count at ART start. The rate of first OI markedly decreased in children who started ART in more recent years. There remains a clear need for improvement in HIV control strategies in children, by promoting earlier diagnosis and timely treatment.</description><subject>Acquired immune deficiency syndrome</subject><subject>Adolescent</subject><subject>Adolescents</subject><subject>Age</subject><subject>AIDS</subject><subject>Ambulatory Care</subject><subject>Analysis</subject><subject>Anti-Retroviral Agents - therapeutic use</subject><subject>Antiretroviral agents</subject><subject>Antiretroviral drugs</subject><subject>Antiretroviral therapy</subject><subject>Antiviral agents</subject><subject>Asia - epidemiology</subject><subject>Biology and Life Sciences</subject><subject>CD4 antigen</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Children</subject><subject>Drug therapy</subject><subject>Evidence-based medicine</subject><subject>Female</subject><subject>Health aspects</subject><subject>Highly active antiretroviral therapy</subject><subject>HIV</subject><subject>HIV (Viruses)</subject><subject>HIV infection in children</subject><subject>HIV Infections - drug therapy</subject><subject>HIV Infections - epidemiology</subject><subject>HIV patients</subject><subject>HIV testing</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Immune system</subject><subject>Immunodeficiency</subject><subject>Male</subject><subject>Medical diagnosis</subject><subject>Medical records</subject><subject>Medical research</subject><subject>Medicine and Health Sciences</subject><subject>Medicine, Experimental</subject><subject>Missing data</subject><subject>Opportunistic Infections</subject><subject>Patient outcomes</subject><subject>Patients</subject><subject>Pediatrics</subject><subject>People and Places</subject><subject>Regression analysis</subject><subject>Risk analysis</subject><subject>Risk 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changing characteristics of a cohort of children and adolescents living with HIV at antiretroviral therapy initiation in Asia</title><author>Sornillo, Johanna Beulah ; Ditangco, Rossana ; Kinikar, Aarti ; Wati, Dewi Kumara ; Du, Quy Tuan ; Nguyen, Dinh Qui ; Khol, Vohith ; Nguyen, Lam Van ; Puthanakit, Thanyawee ; Ounchanum, Pradthana ; Kurniati, Nia ; Chokephaibulkit, Kulkanya ; Jamal Mohamed, Thahira A ; Sudjaritruk, Tavitiya ; Fong, Siew Moy ; Kumarasamy, Nagalingeswaran ; Kosalaraksa, Pope ; Nallusamy, Revathy A ; Nik Yusoff, Nik Khairulddin ; Sohn, Annette H ; Kariminia, Azar</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c642t-cdb5c3c483947e5f74c49f9e8d7b24c331b170b8d33959940b26820e4b81aeb13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Acquired immune deficiency 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of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sornillo, Johanna Beulah</au><au>Ditangco, Rossana</au><au>Kinikar, Aarti</au><au>Wati, Dewi Kumara</au><au>Du, Quy Tuan</au><au>Nguyen, Dinh Qui</au><au>Khol, Vohith</au><au>Nguyen, Lam Van</au><au>Puthanakit, Thanyawee</au><au>Ounchanum, Pradthana</au><au>Kurniati, Nia</au><au>Chokephaibulkit, Kulkanya</au><au>Jamal Mohamed, Thahira A</au><au>Sudjaritruk, Tavitiya</au><au>Fong, Siew Moy</au><au>Kumarasamy, Nagalingeswaran</au><au>Kosalaraksa, Pope</au><au>Nallusamy, Revathy A</au><au>Nik Yusoff, Nik Khairulddin</au><au>Sohn, Annette H</au><au>Kariminia, Azar</au><aucorp>TREAT Asia Pediatric HIV Observational Database of IeDEA Asia-Pacific</aucorp><aucorp>on behalf of the TREAT Asia Pediatric HIV Observational Database of IeDEA Asia-Pacific</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The changing characteristics of a cohort of children and adolescents living with HIV at antiretroviral therapy initiation in Asia</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2023-09-14</date><risdate>2023</risdate><volume>18</volume><issue>9</issue><spage>e0291523</spage><pages>e0291523-</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Despite improvements in HIV testing and earlier antiretroviral therapy (ART) initiation in children living with HIV through the years, a considerable proportion start treatment with advanced disease. We studied characteristics of children and adolescents living with HIV and their level of immunodeficiency at ART initiation using data from a multi-country Asian cohort. We included children and adolescents who were ART-naïve and <18 years of age at ART initiation from 2011 to 2020 at 17 HIV clinics in six countries. Incidence rates of opportunistic infections (OIs) in the first two years of triple-drug ART (≥3 antiretrovirals) was also reported. Competing risk regression analysis was performed to identify factors associated with first occurrence of OI. In 2,027 children and adolescents (54% males), median age at ART initiation increased from 4.5 years in 2011-2013 to 6.7 in 2017-2020, median CD4 count doubled from 237 cells/μl to 466 cells/μl, and proportion of children who initiated ART as severely immunodeficient decreased from 70% to 45%. During follow-up, 275 (14%) children who received triple-drug ART as first treatment and had at least one clinic visit, developed at least one OI in the first two years of treatment (9.40 per 100 person-years). The incidence rate of any first OI declined from 12.52 to 7.58 per 100 person-years during 2011-2013 and 2017-2020. Lower hazard of OIs were found in those with age at first ART 2-14 years, current CD4 ≥200 cells/μl, and receiving ART between 2017 and 2020. The analysis demonstrated increasing number of children and adolescents starting ART with high CD4 count at ART start. The rate of first OI markedly decreased in children who started ART in more recent years. There remains a clear need for improvement in HIV control strategies in children, by promoting earlier diagnosis and timely treatment.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>37708128</pmid><doi>10.1371/journal.pone.0291523</doi><tpages>e0291523</tpages><orcidid>https://orcid.org/0000-0002-6380-6672</orcidid><orcidid>https://orcid.org/0000-0002-3686-4623</orcidid><orcidid>https://orcid.org/0000-0001-8331-0845</orcidid><orcidid>https://orcid.org/0000-0002-6572-3694</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2023-09, Vol.18 (9), p.e0291523 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2864887730 |
| source | Public Library of Science (PLoS) Journals Open Access; MEDLINE; DOAJ Directory of Open Access Journals; EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Acquired immune deficiency syndrome Adolescent Adolescents Age AIDS Ambulatory Care Analysis Anti-Retroviral Agents - therapeutic use Antiretroviral agents Antiretroviral drugs Antiretroviral therapy Antiviral agents Asia - epidemiology Biology and Life Sciences CD4 antigen Child Child, Preschool Children Drug therapy Evidence-based medicine Female Health aspects Highly active antiretroviral therapy HIV HIV (Viruses) HIV infection in children HIV Infections - drug therapy HIV Infections - epidemiology HIV patients HIV testing Human immunodeficiency virus Humans Immune system Immunodeficiency Male Medical diagnosis Medical records Medical research Medicine and Health Sciences Medicine, Experimental Missing data Opportunistic Infections Patient outcomes Patients Pediatrics People and Places Regression analysis Risk analysis Risk factors Statistics Teenagers |
| title | The changing characteristics of a cohort of children and adolescents living with HIV at antiretroviral therapy initiation in Asia |
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