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Short-term risk of disease progression in HIV-1-infected children receiving no antiretroviral therapy or zidovudine monotherapy: a meta-analysis
- Source :
- The Lancet. 362:1605-1611
- Publication Year :
- 2003
- Publisher :
- Elsevier BV, 2003.
-
Abstract
- Background Data on the short-term risk of disease progression in HIV-1-infected children are needed to address the question of when to begin combination antiretroviral therapy. We estimated 12-month risks of progression to AIDS and death, by age and most recent measurement of CD4 T-cell percentage (CD4%) or viral load, in children receiving no antiretroviral therapy or zidovudine monotherapy only. Methods We undertook a meta-analysis of individual longitudinal data for 3941 children from eight cohort studies and nine randomised trials in Europe and the USA. Estimates of risk were derived from parametric survival models. Findings 997 AIDS-defining events were recorded over 7297 person-years of follow-up in the analysis of CD4%, and 284 events over 2282 person-years in the viral load analysis, corresponding to 568 deaths (9087 person-years) and 129 deaths (2816 person-years), respectively. In children older than 2 years, risk of death increased sharply when CD4% was less than about 10%, or 15% for risk of AIDS, with a low and fairly stable risk at greater CD4%. Children younger than 2 years had worse outlook than older children with the same CD4%. Risk of progression increased when viral load exceeded about 10(5) copies per mL, although this association was more gradual compared with CD4%. Both markers had independent predictive value for disease progression; CD4% was the stronger predictor. Interpretation This information is important for paediatricians making decisions, and for researchers designing trials, about when to initiate or restart antiretroviral therapy.
- Subjects :
- Risk
Pediatrics
medicine.medical_specialty
Adolescent
HIV Infections
law.invention
Zidovudine
Randomized controlled trial
Acquired immunodeficiency syndrome (AIDS)
law
medicine
Humans
Risk factor
Child
Survival analysis
Acquired Immunodeficiency Syndrome
business.industry
Infant
General Medicine
Viral Load
medicine.disease
CD4 Lymphocyte Count
Child, Preschool
Immunology
Disease Progression
HIV-1
Viral disease
business
Viral load
medicine.drug
Cohort study
Subjects
Details
- ISSN :
- 01406736
- Volume :
- 362
- Database :
- OpenAIRE
- Journal :
- The Lancet
- Accession number :
- edsair.doi.dedup.....9d578cec4892fecaf0dfb3b4be17b00b