Long-term risk of mortality and loss to follow-up in children and adolescents on antiretroviral therapy in Asia

Nimkar S 1 , Kinikar A 1 , Mave V 1 , Khol V 2 , Du QT 3 , Nguyen L 4 Show all authors , Ounchanum P 5 , Nguyen DQ 6 , Puthanakit T 7 , Kosalaraks P 8 , Chokephaibulkit K 9 , Sudjaritruk T 10 , Muktiarti D 11 , Kumarasamy N 12 , Yusoff NKN 13 , Mohamed T 14 , Wati D 15 , Alam A 16 , Fong S 17 , Nallusamy R 18 , Suwanlerk T 19 , Sohn A 19 , Kariminia A 20 , TREAT Asia Pediatric HIV Observational Database of IeDEA Asia‐Pacific

Affiliations 

  • 1 B J Govt Medical College - Johns Hopkins University, Clinical Research Site, Pune, India
  • 2 National Centre for HIV/AIDS, Dermatology and STDs, Phnom Penh, Cambodia
  • 3 Infectious Diseases Department, Children's Hospital 1, Ho Chi Minh City, Vietnam
  • 4 Infectious Diseases Department, National Hospital of Pediatrics, Hanoi, Vietnam
  • 5 Department of Pediatrics, Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand
  • 6 Infectious Disease Department, Children's Hospital 2, Ho Chi Minh City, Vietnam
  • 7 Department of Pediatrics and Center of Excellence for Pediatric Infectious Diseases and Vaccines, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
  • 8 Division of Infectious Disease, Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
  • 9 Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
  • 10 Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
  • 11 Faculty of Medicine, Dr. Cipto Mangunkusumo-Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
  • 12 VHS-Infectious Diseases Medical Centre, Chennai, India
  • 13 Department of Pediatrics, Hospital Raja Perempuan Zainab II, Kota Bharu, Malaysia
  • 14 Department of Pediatrics, Women and Children Hospital Kuala Lumpur (WCHKL), Kuala Lumpur, Malaysia
  • 15 Faculty of Medicine, Udayana University-Prof. Dr. I.G.N.G. Ngoerah Hospital, Bali, Indonesia
  • 16 Faculty of Medicine, Hasan Sadikin General Hospital, Bandung, Indonesia
  • 17 Department of Pediatrics, Hospital Likas, Kota Kinabalu, Malaysia
  • 18 Department of Pediatrics Penang Hospital, Penang, Malaysia
  • 19 TREAT Asia, amfAR - The Foundation for AIDS Research, Bangkok, Thailand
  • 20 The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
HIV Med, 2025 Jan;26(1):140-152.
PMID: 39324422 DOI: 10.1111/hiv.13718

Abstract

OBJECTIVE: We described mortality and loss to follow-up (LTFU) in children and adolescents who were under care for more than 5 years following initiation of antiretroviral therapy (ART).

METHODS: Patients were followed from 5 years after ART until the earlier of their 25th birthday, last visit, death, or LTFU. We used Cox regression to assess predictors of mortality and competing risk regression to assess factors associated with LTFU.

RESULTS: In total, 4488 children and adolescents initiating ART between 1997 and 2016 were included in the analysis, with a median follow-up time of 5.2 years. Of these, 107 (2.2%) died and 271 (6.0%) were LTFU. Mortality rate was 4.35 and LTFU rate 11.01 per 1000 person-years. Increased mortality was associated with AIDS diagnosis (adjusted hazard ratio [aHR] 1.71; 95% confidence interval [CI] 1.24-2.37), current CD4 count <350 cells/mm3 compared with ≥500 (highest aHR 13.85; 95% CI 6.91-27.76 for CD4 <200), viral load ≥10 000 copies/mL compared with <400 (aHR 3.28; 95% CI 1.90-5.63), and exposure to more than one ART regimen (aHR 1.51; 95% CI 1.14-2.00). Factors associated with LTFU were male sex (adjusted subdistribution hazard ratio [asHR] 1.29; 95% CI 1.04-1.59), current viral load >1000 copies/mL compared with <400 (highest asHR 2.36; 95% CI 1.19-4.70 for viral load 1000-9999), and ART start after year 2005 compared with ≤2005 (highest asHR 5.96; 95% CI 1.98-17.91 for 2010-2016).

CONCLUSION: For children and adolescents surviving 5 years on ART, both current CD4 and viral load remained strong indicators that help to keep track of their treatment outcomes. More effort should be made to monitor patients who switch treatments.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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