Information de reference pour ce titreAccession Number: | 00126334-201011010-00007.
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Author: | Charlebois, Edwin D MPH, PhD *; Ruel, Theodore D MD *; Gasasira, Anne F MBChB MPH +; Achan, Jane MBChB, MMed ++; Kateera, Frederick MBChB ++; Akello, Caroline MBChB ++; Cao, Huyen MD [S]; Dorsey, Grant MD, PhD *; Rosenthal, Philip J MD *; Ssewanyana, Isaac BSc ||; Kamya, Moses R MBChB, MMed, MPH ++; Havlir, Diane V MD *
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Institution: | From the *School of Medicine, University of California, San Francisco, CA; +School of Public Health, University of California, Berkeley, CA; ++Department of Medicine, Makerere University School of Medicine, Kampala, Uganda; [S]California Department of Health Services, Richmond, CA; and ||Joint Clinical Research Centre, Kampala, Uganda.
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Title: | |
Source: | JAIDS Journal of Acquired Immune Deficiency Syndromes. 55(3):330-335, November 1, 2010.
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Abstract: | Background: Increasing numbers of HIV-infected children not yet eligible for antiretroviral therapy (ART) are entering health care in Africa. We sought to characterize the risk of short-term disease progression in this population.
Methods: In a cohort of HIV-infected ART-naive and -ineligible Ugandan children older than 1 year, the rates of clinical/immunologic progression within 2 years were assessed using Kaplan-Meier survival analysis and multivariate Cox proportional-hazards modeling.
Results: Among 192 children (mean age: 6.4 years, CD4%:25), 19% progressed within 2 years by World Health Organization stage 3/4 event (n = 22), death (n = 3), or World Health Organization-defined CD4 threshold for ART initiation (n = 12). Significant univariate predictors were CD4% [hazard ratio (HR) = 2.0 per 10% decrease, P = 0.005], HIV RNA level (HR = 2.4 per log10 increase, P = 0.002), male gender (HR = 2.0, P = 0.04), age < 3 years (HR = 3.7, P = 0.001), CD4 activation (%CD4+ CD38+ HLADR+) (HR = 1.6 per 10% increase, P = 0.05), and CD8 activation (%CD8+ CD38+ HLADR+) (HR = 1.3 per 10% increase, P = 0.05] (HR = 1.3, P = 0.5). In multivariate analysis, CD4% (HR = 2.0, P = 0.034), HIV RNA level (HR = 1.8, P = 0.013), and age < 3 years (HR = 3.0, P = 0.008) were independently predictive. Children with HIV RNA >105 copies per milliliter and CD4% <25 had progression rates of 29% (1 year) and 34% (2 years).
Conclusions: Even with frequent CD4 monitoring, HIV-infected Ugandan children experienced significant clinical events while ineligible for ART per WHO 2006 guidelines.
(C) 2010 Lippincott Williams & Wilkins, Inc.
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Author Keywords: | HIV; children; progression; monitoring; resource limited.
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Language: | English.
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Document Type: | Clinical Science.
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Journal Subset: | Nursing. Clinical Medicine. Health Professions.
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ISSN: | 1525-4135
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DOI Number: | https://dx.doi.org/10.1097/QAI.0...- ouverture dans une nouvelle fenêtre
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