Evidence map›Paper›PMID 26658814›Full record

ArticlePloS one2015

Clinical, Virologic, Immunologic Outcomes and Emerging HIV Drug Resistance Patterns in Children and Adolescents in Public ART Care in Zimbabwe.

A T Makadzange, M Higgins-Biddle, B Chimukangara, R Birri, M Gordon, T Mahlanza, G McHugh, J H van Dijk, M Bwakura-Dangarembizi, T Ndung'u and 6 more

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in PloS one, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 46 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
46citing papers in PubMed, 3 pooled it
2.3field-weighted citation impact, top 12% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

46 citing papers in PubMed, 3 syntheses or guidelines pooled it, 70 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors at 6 institutions in 3 countries.

A T MakadzangeRagon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts, United States of America.
M Higgins-BiddleJohn Snow Inc, Boston, Massachusetts, United States of America.
B ChimukangaraDepartment of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe.
R BirriDepartment of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe.
M GordonHIV Pathogenesis Program, University of Kwa-Zulu Natal, Durban, South Africa.
T MahlanzaDepartment of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe.
G McHughDepartment of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe.
J H van DijkDepartment of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe.
M Bwakura-DangarembiziDepartment of Pediatrics, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe.
T Ndung'uHIV Pathogenesis Program, University of Kwa-Zulu Natal, Durban, South Africa.
C MasimirembwaAfrican Institute of Biomedical Sciences, Harare, Zimbabwe.
B PhelpsUnited States Agency for International Development (USAID), Washington, DC, United States of America.
A AmzelUnited States Agency for International Development (USAID), Washington, DC, United States of America.
B O OjikutuJohn Snow Inc, Boston, Massachusetts, United States of America.
B D WalkerRagon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts, United States of America.
C E NdhlovuDepartment of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe.
University of Zimbabwe · ZWJohn Snow (United States) · USUnited States Agency for International Development · USUniversity of KwaZulu-Natal · ZAAfrican Institute of Biomedical Science and Technology · ZWRagon Institute of MGH, MIT and Harvard · US

Funding

PEPFAR
6 · The paper itself

Abstract

objectiveTo determine immunologic, virologic outcomes and drug resistance among children and adolescents receiving care during routine programmatic implementation in a low-income country.

methodsA cross-sectional evaluation with collection of clinical and laboratory data for children (0-<10 years) and adolescents (10-19 years) attending a public ART program in Harare providing care for pediatric patients since 2004, was conducted. Longitudinal data for each participant was obtained from the clinic based medical record.

resultsData from 599 children and adolescents was evaluated. The participants presented to care with low CD4 cell count and CD4%, median baseline CD4% was lower in adolescents compared with children (11.0% vs. 15.0%, p<0.0001). The median age at ART initiation was 8.0 years (IQR 3.0, 12.0); median time on ART was 2.9 years (IQR 1.7, 4.5). On ART, median CD4% improved for all age groups but remained below 25%. Older age (≥ 5 years) at ART initiation was associated with severe stunting (HAZ <-2: 53.3% vs. 28.4%, p<0.0001). Virologic failure rate was 30.6% and associated with age at ART initiation. In children, nevirapine based ART regimen was associated with a 3-fold increased risk of failure (AOR: 3.5; 95% CI: 1.3, 9.1, p = 0.0180). Children (<10 y) on ART for ≥4 years had higher failure rates than those on ART for <4 years (39.6% vs. 23.9%, p = 0.0239). In those initiating ART as adolescents, each additional year in age above 10 years at the time of ART initiation (AOR 0.4 95%CI: 0.1, 0.9, p = 0.0324), and each additional year on ART (AOR 0.4, 95%CI 0.2, 0.9, p = 0.0379) were associated with decreased risk of virologic failure. Drug resistance was evident in 67.6% of sequenced virus isolates.

conclusionsDuring routine programmatic implementation of HIV care for children and adolescents, delayed age at ART initiation has long-term implications on immunologic recovery, growth and virologic outcomes.

Indexed as

Drug Resistance, ViralAdolescentAge FactorsAnti-HIV AgentsCD4 Lymphocyte CountCD4-Positive T-LymphocytesChildChild, PreschoolCross-Sectional StudiesFemaleHIV-1HIV InfectionsHumansInfantInfant, NewbornMaleAnti-HIV AgentsNevirapine

Identifiers

PMID26658814
PMCPMC4678607
OpenAlexW2204494731

What OpenQuestion holds

Textmetadata
LicenceCC0
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.