Clinical Infectious Diseases Advance Access published November 21, 2012 1
Mortality and treatment outcomes of China’s National Pediatric Antiretroviral
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Therapy Program
Yan Zhao1, Chunming Li1, Xin Sun1, Weiwei Mu1, Jennifer M. McGoogan1, Yun He2, Yuewu
Fujie Zhang1,8,* 1
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Cheng3, Zhirong Tang4, Huiqin Li5, Mingjian Ni6, Ye Ma1, Ray Y. Chen7, Zhongfu Liu1,* and
National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and
Prevention, Beijing, China 2
Provincial Infectious Disease Hospital, Henan, China
3
Shang Cai Country Center for Disease Control and Prevention, Henan, China
4
Provincial Center for Disease Control and Prevention, Guangxi, China
5
Provincial Center for AIDS Care, Yunnan, China
6 7
Ma
Regional Center for Disease Control and Prevention, Xinjiang Uighur Autonomous Region, China
Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health,
Bethesda, MD, USA 8
Beijing Ditan Hospital, Capital Medical University, Beijing, China
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Correspondence: Fujie Zhang, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xi Cheng District, Beijing 100050, PR China; Beijing Ditan Hospital, Capital Medical University, China (E-mail:
[email protected]) and Zhongfu Liu, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing 102206, PR China (E-mail:
[email protected]). *
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Dr. Zhang and Dr. Liu contributed equally to this article.
Summary: HIV-positive children enrolled in China’s national pediatric ART program experience a
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mortality rate of 2.3 per 100 child-years, survival rate of 94%, and improved treatment outcomes including elevated CD4%, hemoglobin, and WAZ and HAZ scores after three years of follow-up.
© The Author 2012. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail:
[email protected]
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ABSTRACT
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Background The aim of this study was to describe three-year mortality rates, associated risk factors, and long-term clinical outcomes of children enrolled in China’s National Free Pediatric Antiretroviral
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Therapy (ART) Program.
Methods Records were abstracted from the national HIV/AIDS case reporting and national pediatric
ART databases for all HIV-positive children ≤15 years old who initiated ART prior to December 2010. Mortality risk factors over three years of follow-up were examined using Cox proportional hazards
regression models. Life tables were used to determine survival rate over time. Longitudinal plots of
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CD4+ T cell percentage (CD4%), hemoglobin level, weight-for-age Z (WAZ) scores, and
height-for-age Z (HAZ) scores were created using generalized estimating equation models. Results Among the 1,818 children included in our cohort, a total of 93 deaths were recorded in 4,022 child-years (CY) of observed time for an overall mortality rate of 2.31 per 100 CY (95% confidence
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interval [CI]: 1.75-2.78). The strongest factor associated with mortality was baseline WAZ score