Ongoing High Prevalence of Severe Immune Suppression Among Children in South Africa
Among children in Southern Africa severe immune suppression (SIS) has declined, but most continue to initiate antiretroviral therapy (ART) with SIS. Using data from South Africa, we describe SIS at ART start and on ART between 2007 and 2020, among children 9 months without a recorded visit. We defin...
Gespeichert in:
| Veröffentlicht in: | Journal of acquired immune deficiency syndromes (1999) 2023-04, Vol.92 (4), p.273-280 |
|---|---|
| Hauptverfasser: | , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 280 |
|---|---|
| container_issue | 4 |
| container_start_page | 273 |
| container_title | Journal of acquired immune deficiency syndromes (1999) |
| container_volume | 92 |
| creator | Patten, Gabriela Sipambo, Nosisa Technau, Karl-Günter Euvrard, Jonathan Ford, Nathan Davies, Mary-Ann |
| description | Among children in Southern Africa severe immune suppression (SIS) has declined, but most continue to initiate antiretroviral therapy (ART) with SIS.
Using data from South Africa, we describe SIS at ART start and on ART between 2007 and 2020, among children 9 months without a recorded visit. We defined SIS according to age and CD4%/cell count. A multistate model was used to estimate transition probabilities between 5 states: SIS on ART; Stable, not SIS; Early Gap, commencing |
| doi_str_mv | 10.1097/QAI.0000000000003137 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_9974841</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2778624755</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4351-42bb5b6d3cca0331edad02580f4a579006d5581506c86c30ccd829650514afc73</originalsourceid><addsrcrecordid>eNpdkV9rFDEUxYMotl39BiIBX3yZmr-TmRdhWWq7UKiy-hyymTs7qZlkTWa2-O3N0lpr85JAzvlx7zkIvaPknJJWffq2XJ-TJ4dTrl6gU9oKUammES_LWzJZCcrlCTrL-ZYQWgvRvkYnvFaslZKfos1N2EUXdvjK7Qb8NcHBeAgWcOzxBg6QAK_HcQ6AN_N-nyBnFwNejrFYVoPzXYKAXcCbOE8DXvbJWfMGveqNz_D24V6gH18uvq-uquuby_VqeV1ZwSWtBNtu5bbuuLWGcE6hMx1hsiG9MFK1hNSdlA2VpLZNbTmxtmtYW0siqTC9VXyBPt9z9_N2hM5CmJLxep_caNJvHY3T__8EN-hdPOi2VaIpuSzQxwdAir9myJMeXbbgvQkQ56yZUsc4GW2L9MMz6W2cUyjrHVVNzYQqeS6QuFfZFHNO0D8OQ4k-tqZLa_p5a8X2_ukij6a_Nf3j3kU_Qco__XwHSQ9g_DQUHmU156JihHEiCCXVEU35Hwl9oT4</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2778624755</pqid></control><display><type>article</type><title>Ongoing High Prevalence of Severe Immune Suppression Among Children in South Africa</title><source>MEDLINE</source><source>Journals@Ovid LWW Legacy Archive</source><source>Free E- Journals</source><creator>Patten, Gabriela ; Sipambo, Nosisa ; Technau, Karl-Günter ; Euvrard, Jonathan ; Ford, Nathan ; Davies, Mary-Ann</creator><creatorcontrib>Patten, Gabriela ; Sipambo, Nosisa ; Technau, Karl-Günter ; Euvrard, Jonathan ; Ford, Nathan ; Davies, Mary-Ann</creatorcontrib><description>Among children in Southern Africa severe immune suppression (SIS) has declined, but most continue to initiate antiretroviral therapy (ART) with SIS.
Using data from South Africa, we describe SIS at ART start and on ART between 2007 and 2020, among children <5 years with a CD4%/cell count at ART start and ≥1 subsequent measure.
Gap in care was defined as >9 months without a recorded visit. We defined SIS according to age and CD4%/cell count. A multistate model was used to estimate transition probabilities between 5 states: SIS on ART; Stable, not SIS; Early Gap, commencing <9 months from ART start; Late Gap, commencing ≥9 months on ART; and Death.
Among 2536 children, 70% had SIS at ART start, and 36% experienced SIS on ART. An increasing proportion were age <1 year at ART initiation (2007-2009: 43% to 2013-2020: 55%). Increasingly, SIS on ART occurred after a gap, in those with SIS on ART for >1 year, and after a period of unknown immune status. Later year of ART initiation was associated with reduced transition from SIS on ART to Stable. Infants and those initiating ART with SIS were more likely to transition from Stable to SIS. Viremia strongly predicted death from both the on ART states.
Increasingly SIS occurred among ART-experienced children. Those starting ART with SIS and during infancy remained especially vulnerable to SIS once on treatment. Managing ART in these children may be more complex and further reducing AIDS-related mortality is likely to remain challenging.</description><identifier>ISSN: 1525-4135</identifier><identifier>EISSN: 1944-7884</identifier><identifier>DOI: 10.1097/QAI.0000000000003137</identifier><identifier>PMID: 36729553</identifier><language>eng</language><publisher>United States: JAIDS Journal of Acquired Immune Deficiency Syndromes</publisher><subject>Africa, Southern ; Anti-HIV Agents - therapeutic use ; Antiretroviral agents ; Antiretroviral therapy ; CD4 antigen ; CD4 Lymphocyte Count ; Child ; Children ; Death ; HIV Infections - drug therapy ; Humans ; Immune status ; Infant ; Prevalence ; South Africa - epidemiology ; Transition probabilities ; Viremia</subject><ispartof>Journal of acquired immune deficiency syndromes (1999), 2023-04, Vol.92 (4), p.273-280</ispartof><rights>JAIDS Journal of Acquired Immune Deficiency Syndromes</rights><rights>Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4351-42bb5b6d3cca0331edad02580f4a579006d5581506c86c30ccd829650514afc73</citedby><cites>FETCH-LOGICAL-c4351-42bb5b6d3cca0331edad02580f4a579006d5581506c86c30ccd829650514afc73</cites><orcidid>0000-0003-2511-1367</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttp://ovidsp.ovid.com/ovidweb.cgi?T=JS&NEWS=n&CSC=Y&PAGE=fulltext&D=ovft&AN=00126334-202304010-00001$$EHTML$$P50$$Gwolterskluwer$$H</linktohtml><link.rule.ids>230,314,776,780,881,4595,27901,27902,65206</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36729553$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Patten, Gabriela</creatorcontrib><creatorcontrib>Sipambo, Nosisa</creatorcontrib><creatorcontrib>Technau, Karl-Günter</creatorcontrib><creatorcontrib>Euvrard, Jonathan</creatorcontrib><creatorcontrib>Ford, Nathan</creatorcontrib><creatorcontrib>Davies, Mary-Ann</creatorcontrib><title>Ongoing High Prevalence of Severe Immune Suppression Among Children in South Africa</title><title>Journal of acquired immune deficiency syndromes (1999)</title><addtitle>J Acquir Immune Defic Syndr</addtitle><description>Among children in Southern Africa severe immune suppression (SIS) has declined, but most continue to initiate antiretroviral therapy (ART) with SIS.
Using data from South Africa, we describe SIS at ART start and on ART between 2007 and 2020, among children <5 years with a CD4%/cell count at ART start and ≥1 subsequent measure.
Gap in care was defined as >9 months without a recorded visit. We defined SIS according to age and CD4%/cell count. A multistate model was used to estimate transition probabilities between 5 states: SIS on ART; Stable, not SIS; Early Gap, commencing <9 months from ART start; Late Gap, commencing ≥9 months on ART; and Death.
Among 2536 children, 70% had SIS at ART start, and 36% experienced SIS on ART. An increasing proportion were age <1 year at ART initiation (2007-2009: 43% to 2013-2020: 55%). Increasingly, SIS on ART occurred after a gap, in those with SIS on ART for >1 year, and after a period of unknown immune status. Later year of ART initiation was associated with reduced transition from SIS on ART to Stable. Infants and those initiating ART with SIS were more likely to transition from Stable to SIS. Viremia strongly predicted death from both the on ART states.
Increasingly SIS occurred among ART-experienced children. Those starting ART with SIS and during infancy remained especially vulnerable to SIS once on treatment. Managing ART in these children may be more complex and further reducing AIDS-related mortality is likely to remain challenging.</description><subject>Africa, Southern</subject><subject>Anti-HIV Agents - therapeutic use</subject><subject>Antiretroviral agents</subject><subject>Antiretroviral therapy</subject><subject>CD4 antigen</subject><subject>CD4 Lymphocyte Count</subject><subject>Child</subject><subject>Children</subject><subject>Death</subject><subject>HIV Infections - drug therapy</subject><subject>Humans</subject><subject>Immune status</subject><subject>Infant</subject><subject>Prevalence</subject><subject>South Africa - epidemiology</subject><subject>Transition probabilities</subject><subject>Viremia</subject><issn>1525-4135</issn><issn>1944-7884</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkV9rFDEUxYMotl39BiIBX3yZmr-TmRdhWWq7UKiy-hyymTs7qZlkTWa2-O3N0lpr85JAzvlx7zkIvaPknJJWffq2XJ-TJ4dTrl6gU9oKUammES_LWzJZCcrlCTrL-ZYQWgvRvkYnvFaslZKfos1N2EUXdvjK7Qb8NcHBeAgWcOzxBg6QAK_HcQ6AN_N-nyBnFwNejrFYVoPzXYKAXcCbOE8DXvbJWfMGveqNz_D24V6gH18uvq-uquuby_VqeV1ZwSWtBNtu5bbuuLWGcE6hMx1hsiG9MFK1hNSdlA2VpLZNbTmxtmtYW0siqTC9VXyBPt9z9_N2hM5CmJLxep_caNJvHY3T__8EN-hdPOi2VaIpuSzQxwdAir9myJMeXbbgvQkQ56yZUsc4GW2L9MMz6W2cUyjrHVVNzYQqeS6QuFfZFHNO0D8OQ4k-tqZLa_p5a8X2_ukij6a_Nf3j3kU_Qco__XwHSQ9g_DQUHmU156JihHEiCCXVEU35Hwl9oT4</recordid><startdate>20230401</startdate><enddate>20230401</enddate><creator>Patten, Gabriela</creator><creator>Sipambo, Nosisa</creator><creator>Technau, Karl-Günter</creator><creator>Euvrard, Jonathan</creator><creator>Ford, Nathan</creator><creator>Davies, Mary-Ann</creator><general>JAIDS Journal of Acquired Immune Deficiency Syndromes</general><general>Lippincott Williams & Wilkins Ovid Technologies</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T2</scope><scope>7T5</scope><scope>7TK</scope><scope>7U7</scope><scope>7U9</scope><scope>C1K</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-2511-1367</orcidid></search><sort><creationdate>20230401</creationdate><title>Ongoing High Prevalence of Severe Immune Suppression Among Children in South Africa</title><author>Patten, Gabriela ; Sipambo, Nosisa ; Technau, Karl-Günter ; Euvrard, Jonathan ; Ford, Nathan ; Davies, Mary-Ann</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4351-42bb5b6d3cca0331edad02580f4a579006d5581506c86c30ccd829650514afc73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Africa, Southern</topic><topic>Anti-HIV Agents - therapeutic use</topic><topic>Antiretroviral agents</topic><topic>Antiretroviral therapy</topic><topic>CD4 antigen</topic><topic>CD4 Lymphocyte Count</topic><topic>Child</topic><topic>Children</topic><topic>Death</topic><topic>HIV Infections - drug therapy</topic><topic>Humans</topic><topic>Immune status</topic><topic>Infant</topic><topic>Prevalence</topic><topic>South Africa - epidemiology</topic><topic>Transition probabilities</topic><topic>Viremia</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Patten, Gabriela</creatorcontrib><creatorcontrib>Sipambo, Nosisa</creatorcontrib><creatorcontrib>Technau, Karl-Günter</creatorcontrib><creatorcontrib>Euvrard, Jonathan</creatorcontrib><creatorcontrib>Ford, Nathan</creatorcontrib><creatorcontrib>Davies, Mary-Ann</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of acquired immune deficiency syndromes (1999)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Patten, Gabriela</au><au>Sipambo, Nosisa</au><au>Technau, Karl-Günter</au><au>Euvrard, Jonathan</au><au>Ford, Nathan</au><au>Davies, Mary-Ann</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Ongoing High Prevalence of Severe Immune Suppression Among Children in South Africa</atitle><jtitle>Journal of acquired immune deficiency syndromes (1999)</jtitle><addtitle>J Acquir Immune Defic Syndr</addtitle><date>2023-04-01</date><risdate>2023</risdate><volume>92</volume><issue>4</issue><spage>273</spage><epage>280</epage><pages>273-280</pages><issn>1525-4135</issn><eissn>1944-7884</eissn><abstract>Among children in Southern Africa severe immune suppression (SIS) has declined, but most continue to initiate antiretroviral therapy (ART) with SIS.
Using data from South Africa, we describe SIS at ART start and on ART between 2007 and 2020, among children <5 years with a CD4%/cell count at ART start and ≥1 subsequent measure.
Gap in care was defined as >9 months without a recorded visit. We defined SIS according to age and CD4%/cell count. A multistate model was used to estimate transition probabilities between 5 states: SIS on ART; Stable, not SIS; Early Gap, commencing <9 months from ART start; Late Gap, commencing ≥9 months on ART; and Death.
Among 2536 children, 70% had SIS at ART start, and 36% experienced SIS on ART. An increasing proportion were age <1 year at ART initiation (2007-2009: 43% to 2013-2020: 55%). Increasingly, SIS on ART occurred after a gap, in those with SIS on ART for >1 year, and after a period of unknown immune status. Later year of ART initiation was associated with reduced transition from SIS on ART to Stable. Infants and those initiating ART with SIS were more likely to transition from Stable to SIS. Viremia strongly predicted death from both the on ART states.
Increasingly SIS occurred among ART-experienced children. Those starting ART with SIS and during infancy remained especially vulnerable to SIS once on treatment. Managing ART in these children may be more complex and further reducing AIDS-related mortality is likely to remain challenging.</abstract><cop>United States</cop><pub>JAIDS Journal of Acquired Immune Deficiency Syndromes</pub><pmid>36729553</pmid><doi>10.1097/QAI.0000000000003137</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0003-2511-1367</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1525-4135 |
| ispartof | Journal of acquired immune deficiency syndromes (1999), 2023-04, Vol.92 (4), p.273-280 |
| issn | 1525-4135 1944-7884 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_9974841 |
| source | MEDLINE; Journals@Ovid LWW Legacy Archive; Free E- Journals |
| subjects | Africa, Southern Anti-HIV Agents - therapeutic use Antiretroviral agents Antiretroviral therapy CD4 antigen CD4 Lymphocyte Count Child Children Death HIV Infections - drug therapy Humans Immune status Infant Prevalence South Africa - epidemiology Transition probabilities Viremia |
| title | Ongoing High Prevalence of Severe Immune Suppression Among Children in South Africa |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-10T21%3A52%3A35IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Ongoing%20High%20Prevalence%20of%20Severe%20Immune%20Suppression%20Among%20Children%20in%20South%20Africa&rft.jtitle=Journal%20of%20acquired%20immune%20deficiency%20syndromes%20(1999)&rft.au=Patten,%20Gabriela&rft.date=2023-04-01&rft.volume=92&rft.issue=4&rft.spage=273&rft.epage=280&rft.pages=273-280&rft.issn=1525-4135&rft.eissn=1944-7884&rft_id=info:doi/10.1097/QAI.0000000000003137&rft_dat=%3Cproquest_pubme%3E2778624755%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2778624755&rft_id=info:pmid/36729553&rfr_iscdi=true |