Observational studyThe Lancet. Global health2024
Predicting mortality within 1 year of ART initiation in children and adolescents living with HIV in sub-Saharan Africa: a retrospective observational cohort study.
Observational study in The Lancet. Global health, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 2 of them syntheses that pooled it.
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Who cites it
5 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Risk and Protective Factors Associated With HIV-Related Mortality in Children Receiving Antiretroviral Therapy: A Model-Based Meta-Regression.JAMA pediatrics · 2026Pooled 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
- Article
- The effect of amphetamine-type stimulants on immune response in HIV-infected individuals: a retrospective cohort study.Frontiers in immunology · 2026Article
- Development with external validation of a prediction model for postoperative acute kidney injury following noncardiac surgery in elderly patients.BMC geriatrics · 2025Article
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Authors and funding
21 authors.
Funding
Abstract
backgroundDifferentiated service delivery (DSD) for children and adolescents living with HIV can improve targeted resource use. We derived a mortality prediction score to guide clinical decision making for children and adolescents living with HIV.
methodsData for this retrospective observational cohort study were evaluated for all children and adolescents living with HIV and initiating antiretroviral therapy (ART); aged 0-19 years; and enrolled at Baylor clinics in Eswatini, Malawi, Lesotho, Tanzania, and Uganda between 2005 and 2020. Data for clinical prediction, including anthropometric values, physical examination, ART, WHO stage, and laboratory tests were captured at ART initiation. Backward stepwise variable selection and logistic regression were performed to develop predictive models for mortality within 1 year of ART initiation. Probabilities of mortality were generated, compared with true outcomes, internally validated, and evaluated against WHO advanced HIV criteria.
findingsThe study population included 16 958 children and adolescents living with HIV and initiated on ART between May 18, 2005, and Dec 18, 2020. Predictive variables for the most accurate model included: age, CD4 percentage, white blood cell count, haemoglobin concentration, platelet count, and BMI Z score as continuous variables, and WHO clinical stage and oedema, abnormal muscle tone and respiratory distress on examination as categorical variables. The area under the curve (AUC) of the predictive model was 0·851 (95% CI 0·839-0·863) in the training set and 0·822 (0·800-0·845) in the test set, compared with 0·606 (0·595-0·617) for the WHO advanced HIV criteria (p<0·0001).
interpretationThis study evaluated a large, multinational population to derive a mortality prediction tool for children and adolescents living with HIV. The model more accurately predicted clinical outcomes than the WHO advanced HIV criteria and has the potential to improve DSD for children and adolescents living with HIV in high-burden settings.
fundingNational Institute of Health Fogarty International Center.
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