ArticleInternational journal of epidemiology2017
Optimal timing of antiretroviral treatment initiation in HIV-positive children and adolescents: a multiregional analysis from Southern Africa, West Africa and Europe.
Article in International journal of epidemiology, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 2 of them syntheses that pooled it.
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Who cites it
25 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- HIV-related mortality time trends among children and young adolescents on antiretroviral therapy by age, treatment duration, and region: a systematic review and meta-regression analysis.The lancet. HIV · 2025Pooled it
- Pooled it
- Is Checking for Sequential Positivity Violations Getting You Down? Try sPoRT!Epidemiology (Cambridge, Mass.) · 2025Article
- Patterns of linear growth among children and adolescents living with HIV on antiretroviral therapy in Zimbabwe and Zambia.BMC infectious diseases · 2025Article
- Achieving equity for children and adolescents with perinatal HIV exposure: an urgent need for a paradigm shift.Journal of the International AIDS Society · 2023Article
- Increasing the initiation of antiretroviral therapy through optimal placement of diagnostic technologies for pediatric HIV in Zimbabwe: A modeling analysis.International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases · 2023Article
- Growth, weight gain and BMI in virally suppressed children on antiretroviral therapy with specific reference to dolutegravir.BMC pediatrics · 2023Article
- Article
- Growth improvement following antiretroviral therapy initiation in children with perinatally-acquired HIV diagnosed in older childhood in Zimbabwe: a prospective cohort study.BMC pediatrics · 2022Article
- Transition to Dolutegravir Is Associated With an Increase in the Rate of Body Mass Index Change in a Cohort of Virally Suppressed Adolescents.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2021Article
- Integrase Strand Transfer Inhibitors and Weight Gain in Children and Youth With Perinatal Human Immunodeficiency Virus in the DC Cohort.Open forum infectious diseases · 2021Article
- A scoping review of studies using observational data to optimise dynamic treatment regimens.BMC medical research methodology · 2021Article
- Using longitudinal targeted maximum likelihood estimation in complex settings with dynamic interventions.Statistics in medicine · 2019Article
- Impact of antiretroviral treatment on height evolution of HIV infected children.BMC pediatrics · 2019Article
- Causal comparative effectiveness analysis of dynamic continuous-time treatment initiation rules with sparsely measured outcomes and death.Biometrics · 2019Article
- The contribution of observational studies in supporting the WHO 'treat all' recommendation for HIV/AIDS.Journal of virus eradication · 2018Article
- A review of time scale fundamentals in the g-formula and insidious selection bias.Current epidemiology reports · 2018Article
- Using Observational Data to Inform HIV Policy Change for Children and Youth.Journal of acquired immune deficiency syndromes (1999) · 2018Observational
- Simulation Modeling and Metamodeling to Inform National and International HIV Policies for Children and Adolescents.Journal of acquired immune deficiency syndromes (1999) · 2018Article
- Growth and pubertal development in HIV-infected adolescents.Current opinion in HIV and AIDS · 2018Review
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Authors and funding
25 authors.
Funding
Abstract
Background: There is limited knowledge about the optimal timing of antiretroviral treatment initiation in older children and adolescents. Methods: A total of 20 576 antiretroviral treatment (ART)-naïve patients, aged 1-16 years at enrolment, from 19 cohorts in Europe, Southern Africa and West Africa, were included. We compared mortality and growth outcomes for different ART initiation criteria, aligned with previous and recent World Health Organization criteria, for 5 years of follow-up, adjusting for all measured baseline and time-dependent confounders using the g-formula. Results: Median (1st;3rd percentile) CD4 count at baseline was 676 cells/mm 3 (394; 1037) (children aged ≥ 1 and < 5 years), 373 (172; 630) (≥ 5 and < 10 years) and 238 (88; 425) (≥ 10 and < 16 years). There was a general trend towards lower mortality and better growth with earlier treatment initiation. In children < 10 years old at enrolment, by 5 years of follow-up there was lower mortality and a higher mean height-for-age z-score with immediate ART initiation versus delaying until CD4 count < 350 cells/mm 3 (or CD4% < 15% or weight-for-age z-score < -2) with absolute differences in mortality and height-for-age z-score of 0.3% (95% confidence interval: 0.1%; 0.6%) and -0.08 (-0.09; -0.06) (≥ 1 and < 5 years), and 0.3% (0.04%; 0.5%) and -0.07 (-0.08; -0.05) (≥ 5 and < 10 years). In those aged > 10 years at enrolment we did not find any difference in mortality or growth with immediate ART initiation, with estimated differences of -0.1% (-0.2%; 0.6%) and -0.03 (-0.05; 0.00), respectively. Growth differences in children aged < 10 years persisted for treatment thresholds using higher CD4 values. Regular follow-up led to better height and mortality outcomes. Conclusions: Immediate ART is associated with lower mortality and better growth for up to 5 years in children < 10 years old. Our results on adolescents were inconclusive.
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