ArticleThe Pediatric infectious disease journal2017
Despite Access to Antiretrovirals for Prevention and Treatment, High Rates of Mortality Persist Among HIV-infected Infants and Young Children.
Article in The Pediatric infectious disease journal, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers, 4 of them syntheses that pooled it.
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Who cites it
27 citing papers in PubMed, 4 syntheses or guidelines pooled it, 41 citations in OpenAlex.
- 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
- Determinants of HIV related mortality in African children on antiretroviral therapy: clinical and immunological insights from a systematic review and meta-analysis.AIDS research and therapy · 2025Pooled it
- The Impact of Undernutrition and Anemia on HIV-Related Mortality Among Children on ART in Sub-Saharan Africa: A Systematic Review and Meta-Analysis.Journal of epidemiology and global health · 2024Pooled it
- Mortality among pediatric patients on HIV treatment in sub-Saharan African countries: a systematic review and meta-analysis.BMC public health · 2019Pooled it
- Trial
- Economic Evaluation of Free Prevention of Mother-to-Child Transmissions (PMTCT) Services to Non-South African Women Living in South Africa.Health services insights · 2025Article
- Barriers and outcomes of therapeutic communication between nurses and patients in Africa: a scoping review.BMC nursing · 2024Article
- Determinants of nonsuppression of HIV viral load among children receiving antiretroviral therapy in the Simiyu region: a cross-sectional study.AIDS research and therapy · 2023Article
- Abacavir safety and effectiveness in young infants with HIV in South African observational cohorts.Antiviral therapy · 2023Observational
- Optimizing antiretroviral therapy for children living with HIV: Experience from an observational cohort in Lesotho.PloS one · 2023Observational
- Article
- Cytomegalovirus Viremia and Clinical Outcomes in Kenyan Children Diagnosed With Human Immunodeficiency Virus (HIV) in Hospital.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2022Observational
- Article
- Effectiveness of a community-based intervention (Konga model) to address the factors contributing to viral load suppression among children living with HIV in Tanzania: a cluster-randomized clinical trial protocol.Biology methods & protocols · 2022Article
- Second-generation mother-to-child HIV transmission in South Africa is characterized by poor outcomes.AIDS (London, England) · 2021Observational
- Variations in the characteristics and outcomes of children living with HIV following universal ART in sub-Saharan Africa (2006-17): a retrospective cohort study.The lancet. HIV · 2021Article
- HIGH-FREQUENCY failure of combination antiretroviral therapy in paediatric HIV infection is associated with unmet maternal needs causing maternal NON-ADHERENCE.EClinicalMedicine · 2020Article
- Earlier Antiretroviral Therapy Initiation and Decreasing Mortality Among HIV-infected Infants Initiating Antiretroviral Therapy Within 3 Months of Age in South Africa, 2006-2017.The Pediatric infectious disease journal · 2020Article
- Impact of Shifts to Birth Testing on Early Infant Diagnosis Program Outcomes in KwaZulu-Natal, South Africa.The Pediatric infectious disease journal · 2019Article
- Early infant diagnosis HIV-1 PCR cycle-threshold predicts infant viral load at birth.Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology · 2019Article
Corrections and comments
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Authors and funding
7 authors at 2 institutions in 2 countries.
Funding
Abstract
backgroundOutcomes of HIV-infected children before widespread use of antiretroviral therapy (ART) for treatment and prevention of mother-to-child transmission (PMTCT) have been well characterized but less is known about children who acquire HIV infection in the context of good ART access.
methodsWe enrolled newly diagnosed HIV-infected children ≤24 months of age at 3 hospitals and 2 clinics in Johannesburg, South Africa. We report ART initiation and mortality rates during 6 months from enrollment and factors associated with mortality.
resultsOf 272 children enrolled, median age 6.1 months, 69.5% were diagnosed during hospitalization. By 6 months postenrollment, 53 (19.5%) died and 73 (26.8%) were lost-to-follow-up. Using Kaplan-Meier analysis, the probability of death by 6 months after enrollment was 23.5%. The median age of death was 9.1 months [95% confidence interval (CI): 8.6-12.0]. Overall, 226 (83%) children initiated ART which was associated with a 71% reduction in risk of death [hazard ratio (HR) = 0.29 (95% CI: 0.15-0.58)]. In multivariable analysis of infant factors, weight-for-age Z score < -2 standard deviation (SD) [HR = 2.43 (95% CI: 1.03-5.73)], CD4 <20% [HR = 3.29 (95% CI: 1.60-6.76)] and identification during hospitalization [HR = 2.89 (95% CI: 1.16-7.25)] were independently associated with mortality. In multivariable analysis of maternal factors, CD4 ≤350/no maternal ART was associated with increased mortality risk [HR = 2.57 (95% CI: 1.19-5.59)] versus CD4 >350/no maternal ART; exposure to maternal/infant antiretrovirals for PMTCT was associated with reduced mortality risk [HR = 0.53 (95% CI: 0.28-0.99)] versus no PMTCT.
conclusionsART initiation is highly protective against death in young children. However, despite improved access to ART, young children remain at risk for early death; innovative approaches to rapidly diagnose and initiate treatment as early in life as possible are needed.
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