CD4 Trends with Evolving Treatment Initiation Policies among Children Living with HIV in Zambézia Province, Mozambique, 2012–2018

Details

• Alternative Title:
  J Acquir Immune Defic Syndr
• Personal Author:
  Carlucci, James G. ; De Schacht, Caroline ; Graves, Erin ; González, Purificación ; Bravo, Magdalena ; Yu, Zhihong ; Amorim, Gustavo ; Arinze, Folasade ; Silva, Wilson ; Tique, Jose A. ; Alvim, Maria Fernanda Sardella ; Simione, Beatriz ; Fernando, Anibal Naftal ; Wester, C. William
• Description:
  Background:
  
  Historically, antiretroviral therapy (ART) initiation was based on CD4 criteria, but this has been replaced with “Test-and-Start” (T&S) wherein all people living with HIV are offered ART. We describe the baseline immunologic status among children relative to evolving ART policies in Mozambique.
  
  Methods:
  
  This retrospective evaluation was performed using routinely collected data. Children living with HIV (CLHIV; 5–14 years) with CD4 data in the period of 2012–2018 were included. ART initiation “policy periods” corresponded to implementation of evolving guidelines: in Period 1 (2012–2016), ART was recommended for CD4<350; during Period 2 (2016–2017), the CD4 threshold increased to <500; T&S was implemented in Period 3 (2017–2018). We described temporal trends in the proportion of children with severe immunodeficiency (CD4<200) at enrollment and at ART initiation. Multivariable regression models were used to estimate associations with severe immunodeficiency.
  
  Results:
  
  The cohort included 1,815 children with CD4 data at enrollment and 1,922 at ART initiation. The proportion of children with severe immunodeficiency decreased over time: 20% at enrollment into care in Period 1 vs. 16% in Period 3 (p=0.113), and 21% at ART start in Period 1 vs. 15% in Period 3 (p=0.004). Children initiating ART in Period 3 had lower odds of severe immunodeficiency at ART start compared to those in Period 1 (aOR=0.67; 95%CI:0.51–0.88). Older age was associated with severe immunodeficiency at enrollment (aOR=1.13; 95%CI:1.06–1.20) and at ART initiation (aOR=1.14; 95%CI:1.08–1.21).
  
  Conclusions:
  
  The proportion of children with severe immunodeficiency at ART initiation decreased alongside more inclusive ART initiation guidelines. Earlier treatment of CLHIV is imperative.
  
  
• Subjects:
  Adolescent Anti-HIV Agents CD4 Lymphocyte Count Child Child, Preschool HIV Infections Humans Mozambique Policy Retrospective Studies
• Keywords:
  Antiretroviral Therapy CD4 Cell Count Children HIV
• Source:
  J Acquir Immune Defic Syndr. 89(3):288-296
• Pubmed ID:
  34840319
• Pubmed Central ID:
  PMC8826612
• Document Type:
  Journal Article
• Funding:
  U2G GH000812/GH/CGH CDC HHSUnited States/ ; PEPFAR/PEPFARUnited States/
• Volume:
  89
• Issue:
  3
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:fbd5bdeda4accd80ccb31a884b9a92f8391651cab51b3cb6de48a6aa10348882deb88383d633d3b038a4a05181486523654bfe1766b259b0ec1f3e6e123bbd2b
• Download URL:
  https://stacks.cdc.gov/view/cdc/114456/cdc_114456_DS1.pdf
• File Type:
  [PDF - 281.47 KB ]