ArticleEpidemiology (Cambridge, Mass.)2016
Growth and Mortality Outcomes for Different Antiretroviral Therapy Initiation Criteria in Children Ages 1-5 Years: A Causal Modeling Analysis.
Article in Epidemiology (Cambridge, Mass.), 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers.
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Who cites it
18 citing papers in PubMed.
- Documenting HIV service delivery and adoption of evidence-based practices in HIV care programs: A protocol for a cross-sectional survey of HIV clinics participating in the International epidemiology Databases to Evaluate AIDS (IeDEA).medRxiv : the preprint server for health sciences · 2026Article
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- Invited commentary: mixing multiple imputation and bootstrapping for variance estimation.American journal of epidemiology · 2024Article
- Association Between Remnant Cholesterol and Risk of Incident Atrial Fibrillation: Population-Based Evidence From a Large-Scale Prospective Cohort Study.Journal of the American Heart Association · 2024Article
- Treatment outcomes among children younger than five years living with HIV in rural Zambia, 2008-2018: a cohort study.BMC pediatrics · 2021Article
- A scoping review of studies using observational data to optimise dynamic treatment regimens.BMC medical research methodology · 2021Article
- Undernutrition and Its Associated Factors Among Human Immunodeficiency Virus Infected Children on Follow Up in Amhara Region Referral Hospitals, Ethiopia, 2020.Global pediatric health · 2021Article
- Using longitudinal targeted maximum likelihood estimation in complex settings with dynamic interventions.Statistics in medicine · 2019Article
- The contribution of observational studies in supporting the WHO 'treat all' recommendation for HIV/AIDS.Journal of virus eradication · 2018Article
- 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 · 2018Article
- A review of time scale fundamentals in the g-formula and insidious selection bias.Current epidemiology reports · 2018Article
- Simulation Modeling and Metamodeling to Inform National and International HIV Policies for Children and Adolescents.Journal of acquired immune deficiency syndromes (1999) · 2018Article
- Bootstrap inference when using multiple imputation.Statistics in medicine · 2018Article
- Optimal timing of antiretroviral treatment initiation in HIV-positive children and adolescents: a multiregional analysis from Southern Africa, West Africa and Europe.International journal of epidemiology · 2017Article
- Paediatric European Network for Treatment of AIDS Treatment Guideline 2016 update: antiretroviral therapy recommended for all children living with HIV.HIV medicine · 2017Article
- Survival of HIV-1 vertically infected children.Current opinion in HIV and AIDS · 2016Article
- Getting to 90-90-90 in paediatric HIV: What is needed?Journal of the International AIDS Society · 2015Article
- Targeting 90-90-90--don't leave children and adolescents behind.Journal of the International AIDS Society · 2015Article
Corrections and comments
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Authors and funding
22 authors.
Funding
Abstract
backgroundThere is limited evidence regarding the optimal timing of initiating antiretroviral therapy (ART) in children. We conducted a causal modeling analysis in children ages 1-5 years from the International Epidemiologic Databases to Evaluate AIDS West/Southern-Africa collaboration to determine growth and mortality differences related to different CD4-based treatment initiation criteria, age groups, and regions.
methodsART-naïve children of ages 12-59 months at enrollment with at least one visit before ART initiation and one follow-up visit were included. We estimated 3-year growth and cumulative mortality from the start of follow-up for different CD4 criteria using g-computation.
resultsAbout one quarter of the 5,826 included children was from West Africa (24.6%).The median (first; third quartile) CD4% at the first visit was 16% (11%; 23%), the median weight-for-age z-scores and height-for-age z-scores were -1.5 (-2.7; -0.6) and -2.5 (-3.5; -1.5), respectively. Estimated cumulative mortality was higher overall, and growth was slower, when initiating ART at lower CD4 thresholds. After 3 years of follow-up, the estimated mortality difference between starting ART routinely irrespective of CD4 count and starting ART if either CD4 count <750 cells/mm³ or CD4% <25% was 0.2% (95% CI = -0.2%; 0.3%), and the difference in the mean height-for-age z-scores of those who survived was -0.02 (95% CI = -0.04; 0.01). Younger children ages 1-2 and children in West Africa had worse outcomes.
conclusionsOur results demonstrate that earlier treatment initiation yields overall better growth and mortality outcomes, although we could not show any differences in outcomes between immediate ART and delaying until CD4 count/% falls below 750/25%.
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