Table_1_Treatment Outcomes of HIV Infected Children After Initiation of Antiretroviral Therapy in Southwest China: An Observational Cohort Study.DOCX

BackgroundThe number of HIV infected children receiving antiviral treatment in Guangxi is increasing. Understanding factors and trends of mortality and attrition in HIV-infected children under antiretroviral therapy (ART) was an urgent need to improve treatment outcomes. This study aimed to estimate mortality and attrition rates and identify factors that were associated with mortality and attrition after ART initiation among children with HIV in Guangxi, China between 2004 and 2018.MethodsCohort study data were extracted from the National Free Antiretroviral Treatment Program (NFATP) database, which has standard guidelines for core treatment indicators and other data at all HIV/AIDS treatment facilities in Guangxi. A total of 901 HIV-infected children who have started ART were included in the study. The study collected the following data: age, gender, WHO clinic stages before ART, CD4 cell count before ART, Cotrimoxazole prophylaxis (CTX) use before ART, initial ART regimen, malnutrition before ART, abnormal liver function before ART, abnormal kidney function before ART, severe anemia before ART, and the time lag between an HIV diagnosis and ART initiation.ResultsHIV-infected children under ART had a mortality rate of 0.87 per 100 person-years [95% Confidence Interval (CI) 0.63–1.11], and an attrition rate of 3.02 per 100 person-years (95% CI 2.57–3.47). Mortality was lower among children with a CD4 count between 200 and 500 copies/ml [Adjusted Hazard Ratio (AHR) 0.22, 95% CI 0.09–0.55], and CD4 count ≥500 copies/ml (AHR 0.10, 95% CI 0.03–0.29); but higher among children with late ART initiation at 1–3 months (AHR 2.30, 95% CI 1.07–4.94), and at ≥3 months (AHR 2.22, 95% CI 1.04–4.74). Attrition was lower among children with a CD4 count ≥500 copies/ml (AHR 0.62, 95% CI 0.41–0.95), but higher among children with late ART initiation at 1–3 months (AHR 1.55, 95% CI 1.05–2.30).ConclusionSupportive programs are needed to educate children's families and parents on early ART, link HIV-infected children to care and retain them in care among other programs that treat and manage the medical conditions of HIV-infected children before ART initiation.

背景：广西接受抗病毒治疗的HIV感染儿童数量呈上升趋势。深入了解接受抗逆转录病毒治疗（ART）的HIV感染儿童死亡率及脱落趋势，对于提升治疗效果具有迫切需求。本研究旨在估计2004年至2018年间广西HIV感染儿童在ART启动后的死亡率和脱落率，并识别与死亡率和脱落率相关的因素。方法：从国家免费抗逆转录病毒治疗项目（NFATP）数据库中提取队列研究数据，该数据库对广西所有HIV/AIDS治疗机构的核心理念治疗指标及其他数据进行标准化指导。共纳入901名已开始ART的HIV感染儿童。研究收集了以下数据：年龄、性别、ART前的世界卫生组织（WHO）临床分期、ART前的CD4细胞计数、ART前的复方新诺明（CTX）预防性使用、ART初治方案、ART前的营养不良、ART前的肝功能异常、ART前的肾功能异常、ART前的重度贫血以及HIV诊断与ART启动之间的时间滞后。结果：接受ART的HIV感染儿童死亡率为每100人年0.87[95%置信区间（CI）0.63–1.11]，脱落率为每100人年3.02（95% CI 2.57–3.47）。CD4计数在200至500拷贝/毫升之间的儿童死亡率较低[调整危险比（AHR）0.22，95% CI 0.09–0.55]，CD4计数≥500拷贝/毫升的儿童（AHR 0.10，95% CI 0.03–0.29）亦然；然而，在1-3个月延迟ART启动的儿童中死亡率较高（AHR 2.30，95% CI 1.07–4.94），以及≥3个月延迟启动的儿童（AHR 2.22，95% CI 1.04–4.74）。脱落率在CD4计数≥500拷贝/毫升的儿童中较低（AHR 0.62，95% CI 0.41–0.95），但在1-3个月延迟ART启动的儿童中较高（AHR 1.55，95% CI 1.05–2.30）。结论：有必要制定支持性项目，以教育儿童家庭和家长关于早期ART的重要性，将HIV感染儿童与护理服务相连接，并在其他治疗和管理HIV感染儿童医疗状况的程序中保留他们接受护理。