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Published on: September 6, 2019
Clinical outcomes among HIV positive babies below 18 months of age, diagnosed under the Early Infant Diagnosis (EID)
Suchit Kamble1, Nilesh Gawde2, Shilpa Bembalkar1
1ICMR-National Institute of Translational Virology and AIDS Research, Pune, India.
Insights
Early Antiretroviral Therapy (ART) initiation improves survival in infants with perinatally acquired HIV. However, factors like stigma and access to care impact treatment outcomes, highlighting the need for improved retention in care.
Area of Science:
- Pediatric HIV/AIDS research
- Public health interventions in developing countries
- Immunology and infectious diseases
Background:
- Early Antiretroviral Therapy (ART) initiation is crucial for clinical outcomes and survival in infants with perinatally acquired HIV.
- Early Infant Diagnosis (EID) was implemented in India in 2010, but its impact on infant clinical outcomes and associated determinants remains underreported.
Purpose of the Study:
- To evaluate the impact of Early Infant Diagnosis (EID) and subsequent Antiretroviral Therapy (ART) on the clinical outcomes and survival of infants with perinatally acquired HIV in India.
- To identify determinants associated with ART treatment adherence and clinical outcomes in this vulnerable population.
Main Methods:
- A mixed-methods approach combining quantitative retrospective cohort data from 310 children across 30 ART centers in India.
- In-depth interviews with 67 healthcare providers and managers to explore underlying causes and challenges.
- Analysis of clinical data including baseline CD4 count and WHO clinical stages.
Main Results:
- Three-year survival rate was 91% among infants on ART.
- Lower baseline CD4 counts (<1500 cells/mm³) and advanced WHO clinical stages (III/IV) were significantly associated with higher mortality and opportunistic infections.
- Demand-side (stigma, desperation) and supply-side (access, drug formulation) factors impacted ART treatment.
Conclusions:
- While survival is good for infants retained in care, mortality remains high for those with poor immunological and clinical parameters.
- Ensuring retention in care is critical for improving clinical outcomes in infants with perinatally acquired HIV.
- Addressing socio-economic barriers and improving healthcare access are essential for effective HIV management in infants.
Background:
Early Anti-Retroviral Therapy (ART) initiation among infants with perinatally acquired HIV is known to impact clinical outcomes and survival. Early Infant Diagnosis (EID) was initiated in programme settings in India in 2010. Its impact on the clinical outcomes of infants covered under the programme and associated determinants have not been reported.
Methods:
This was a mixed-methods study. Quantitative clinical data of 310 children on ART with HIV diagnosis before 18 months of age was collected from the treatment cards across 30 ART centres from 11 states of India using a retrospective cohort design. A total of 67 In-depth interviews with healthcare providers and managers helped to understand the underlying causes.
Findings:
Out of 310 infants, 200 (64.5%) were on ART, and 36 (11.6%) were lost to follow-up, and 25 (8.1%) had died. The median age at HIV diagnosis was 231.5 (130, 405) days, and the median age at ART initiation was 309 (198, 456) days. Three-year survival was 91%. Baseline CD4 count less than 1500 cells/mm3 had a higher hazard for mortality (hazard ratio 11.39 (CI: 1.45, 89.45), p = 0.021) as well as for either mortality or development of opportunistic infections (hazard ratio 4.87 (CI: 1.56, 15.15), p = 0.006). WHO clinical stages III and IV had hazard ratios of 2.42 ((CI: 1.43, 4.09), p = 0.001) for mortality and 1.92 ((CI: 1.28, 2.88), p = 0.001) for death or development of opportunistic infections. Demand-side issues such as stigma and discrimination at family, community, and societal levels, desperation about the survival of the child, supply-side factors such as remote access to paediatric ART centres, and lack of paediatric ART medicine formulations were associated with ART treatment.
Interpretation:
Overall survival was good for those who continued on treatment, but mortality was high for those with poor immunological and clinical parameters. Retention in care needs to be ensured for better clinical outcomes.
Funding:
The study was commissioned by the National AIDS Control Programme (T.11020/98/2014-NACO (R&D)) and funded through The Global Fund Against AIDS, TB and Malaria (GFATM) grant.
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