Early Antiretroviral Therapy Initiation and Mortality among Infants Diagnosed with HIV in the First 12 Weeks of Life: Experiences from Kinshasa, DR Congo and Blantyre, Malawi

Citation

Sheahan, Anna; Feinstein, Lydia; Dube, Queen; Edmonds, Andrew; Chirambo, Chawanangwa Mahebere; Smith, Emily R.; Behets, Frieda M.-T. F.; Heyderman, Robert; & Van Rie, Annelies T. (2017). Early Antiretroviral Therapy Initiation and Mortality among Infants Diagnosed with HIV in the First 12 Weeks of Life: Experiences from Kinshasa, DR Congo and Blantyre, Malawi. Pediatric Infectious Disease Journal, 36(7), 654-658. PMCID: PMC5468473

Abstract

BACKGROUND: Based on clinical trial results, the WHO recommends infant HIV testing at age 4-6 weeks and immediate antiretroviral therapy (ART) initiation in all HIV-infected infants. Little is known about the outcomes of HIV infected infants diagnosed with HIV in the first weeks of life in resource-limited settings. We assessed ART initiation and mortality in the first year of life among infants diagnosed with HIV by 12 weeks of age.
METHODS: Cohort of HIV-infected infants in Kinshasa and Blantyre diagnosed before 12 weeks to estimate 12-month cumulative incidences of ART initiation and mortality, accounting for competing risks. Multivariate models were used to estimate associations between infant characteristics and timing of ART initiation.
RESULTS: 121 infants were diagnosed at a median age of 7 weeks (interquartile range 6-8). The cumulative incidence of ART initiation was 46% (95% CI: 36%, 55%) at 6 months and 70% (95% CI: 60%, 78%) at 12 months. Only age at HIV diagnosis was associated with ART initiation by age 6 months, with a subdistribution hazard ratio of 0.70 (95% CI: 0.52, 0.91) for each week increase in age at DNA PCR test. The 12-month cumulative incidence of mortality was 20% (95% CI: 13%, 28%).
CONCLUSIONS: Despite early diagnosis of HIV, ART initiation was slow and mortality remained high, underscoring the complexity in translating clinical trial findings and WHO guidance into real-life practice. Novel and creative health system interventions will be required to ensure that all HIV infected infants achieve optimal treatment outcomes under routine care settings.

URL

http://dx.doi.org/10.1097/inf.0000000000001539

Reference Type

Journal Article

Year Published

2017

Journal Title

Pediatric Infectious Disease Journal

Author(s)

Sheahan, Anna
Feinstein, Lydia
Dube, Queen
Edmonds, Andrew
Chirambo, Chawanangwa Mahebere
Smith, Emily R.
Behets, Frieda M.-T. F.
Heyderman, Robert
Van Rie, Annelies T.

PMCID

PMC5468473