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Survival Benefit of Early Infant Antiretroviral Therapy is Compromised When Diagnosis is Delayed

Wamalwa, Dalton MBChB, MPH, MMed Paed*; Benki-Nugent, Sarah MS, PhD; Langat, Agnes MBChB, MMed Paed*; Tapia, Ken MS; Ngugi, Evelyn MBChB*; Slyker, Jennifer A. PhD; Richardson, Barbra A. PhD§‡¶; John-Stewart, Grace C. MD, PhD

The Pediatric Infectious Disease Journal: July 2012 - Volume 31 - Issue 7 - p 729–731
doi: 10.1097/INF.0b013e3182587796
HIV Reports

Late presentation is common among African HIV-1–infected infants. Incidence and correlates of mortality were examined in 99 infants with HIV-1 diagnosis by 5 months of age. Twelve-month survival was 66.8% (95% confidence interval: 55.9–75.6%). World Health Organization stage 3 or 4, underweight, wasting, microcephaly, low hemoglobin, pneumonia and gastroenteritis predicted mortality. Early HIV-1 diagnosis with antiretroviral therapy before symptomatic disease is critical for infant survival.

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From the *Department of Paediatrics, University of Nairobi, Nairobi, Kenya; Departments of Medicine, Global Health and §Biostatistics, University of Washington; and the Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA.

Accepted for publication April 02, 2012.

D.W. and S.B.-N. contributed equally to this work.

The OPH03 Study was supported by the U.S. National Institute of Child Health and Disease (NICHD) grant R01 HD23412 and R01 HD023412. D.W. was supported by the Global Research Initiative Program, Social Science (R01 TW007632); S.B.-N. was supported by NICHD grant R01 HD023412; G.J.-S. was supported by the National Institutes of Health (NIH) grant K24 HD054314. Field site support was provided by the University of Washington Center for AIDS Research International Core, an NIH-funded program (P30 AI027757), which is supported by the following NIH Institutes and Centers (NIAID, NCI, NIMH, NIDA, NICHD, NHLBI, NCCAM). Antiretroviral drugs and CD4 monitoring were provided by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). The authors have no other funding or conflicts of interest to disclose.

Address for Correspondence: Dalton Wamalwa, MBChB, MPH, MMed Paed, Department of Paediatrics, University of Nairobi, Box 19676, Nairobi 00202, Kenya. E-mail: dalton@africaonline.co.ke.

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© 2012 Lippincott Williams & Wilkins, Inc.