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Panayidou K., Davies M. A., Anderegg N., Egger M., et al., Jourdain Gonzague (collab.), IeDEA Collaboration Group, COHERE Collaboration Group, PHACS Collaboration Group, IMPAACT 219C Collaboration Group. (2018). Global temporal changes in the proportion of children with advanced disease at the start of combination antiretroviral therapy in an era of changing criteria for treatment initiation. Journal of the International Aids Society, 21 (11), e25200 [16 p.]. ISSN 1758-2652

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Lien direct chez l'éditeur doi:10.1002/jia2.25200

Titre
Global temporal changes in the proportion of children with advanced disease at the start of combination antiretroviral therapy in an era of changing criteria for treatment initiation
Année de publication2018
Type de documentArticle référencé dans le Web of Science WOS:000451835200001
AuteursPanayidou K., Davies M. A., Anderegg N., Egger M., et al., Jourdain Gonzague (collab.), IeDEA Collaboration Group, COHERE Collaboration Group, PHACS Collaboration Group, IMPAACT 219C Collaboration Group.
SourceJournal of the International Aids Society, 2018, 21 (11), p. e25200 [16 p.]. p. e25200 [16 p.] ISSN 1758-2652
RésuméIntroduction The CD4 cell count and percent at initiation of combination antiretroviral therapy (cART) are measures of advanced HIV disease and thus are important indicators of programme performance for children living with HIV. In particular, World Health Organization (WHO) 2017 guidelines on advanced HIV disease noted that >80% of children aged <5years started cART with WHO Stage 3 or 4 disease or severe immune suppression. We compared temporal trends in CD4 measures at cART start in children from low-, middle- and high-income countries, and examined the effect of WHO treatment initiation guidelines on reducing the proportion of children initiating cART with advanced disease. MethodsResultsWe included children aged <16years from the International Epidemiology Databases to Evaluate acquired immunodeficiency syndrome (AIDS) (IeDEA) Collaboration (Caribbean, Central and South America, Asia-Pacific, and West, Central, East and Southern Africa), the Collaboration of Observational HIV Epidemiological Research in Europe (COHERE), the North American Pediatric HIV/AIDS Cohort Study (PHACS) and International Maternal Pediatric Adolescent AIDS Clinical Trials (IMPAACT) 219C study. Severe immunodeficiency was defined using WHO guidelines. We used generalized weighted additive mixed effect models to analyse temporal trends in CD4 measurements and piecewise regression to examine the impact of 2006 and 2010 WHO cART initiation guidelines. We included 52,153 children from fourteen low-, eight lower middle-, five upper middle- and five high-income countries. From 2004 to 2013, the estimated percentage of children starting cART with severe immunodeficiency declined from 70% to 42% (low-income), 67% to 64% (lower middle-income) and 61% to 43% (upper middle-income countries). In high-income countries, severe immunodeficiency at cART initiation declined from 45% (1996) to 14% (2012). There were annual decreases in the percentage of children with severe immunodeficiency at cART initiation after the WHO guidelines revisions in 2006 (low-, lower middle- and upper middle-income countries) and 2010 (all countries). Conclusions By 2013, less than half of children initiating cART had severe immunodeficiency worldwide. WHO treatment initiation guidelines have contributed to reducing the proportion of children and adolescents starting cART with advanced disease. However, considerable global inequity remains, in 2013, >40% of children in low- and middle-income countries started cART with severe immunodeficiency compared to <20% in high-income countries.
Plan de classementEntomologie médicale / Parasitologie / Virologie [052] ; Santé : généralités [050]
Descr. géo.AFRIQUE SUBSAHARIENNE ; AMERIQUE DU NORD ; CARAIBE ; AMERIQUE CENTRALE ; AMERIQUE DU SUD ; EUROPE ; ASIE
LocalisationFonds IRD [F B010074756]
Identifiant IRDfdi:010074756
Lien permanenthttp://www.documentation.ird.fr/hor/fdi:010074756

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