CD4 Trends with Evolving Treatment Initiation Policies among Children Living with HIV in Zambézia Province, Mozambique, 2012-2018
AUTHORS
- PMID: 34840319 [PubMed].
ABSTRACT
BACKGROUND: Historically, antiretroviral therapy (ART) initiation was based on CD4 criteria, but this has been replaced with “Test-and-Start” (T&S) wherein all people living with HIV are offered ART. We describe the baseline immunologic status among children relative to evolving ART policies in Mozambique.
METHODS: This retrospective evaluation was performed using routinely collected data. Children living with HIV (CLHIV; 5-14 years) with CD4 data in the period of 2012-2018 were included. ART initiation “policy periods” corresponded to implementation of evolving guidelines: in Period 1 (2012-2016), ART was recommended for CD4<350; during Period 2 (2016-2017), the CD4 threshold increased to <500; T&S was implemented in Period 3 (2017-2018). We described temporal trends in the proportion of children with severe immunodeficiency (CD4<200) at enrollment and at ART initiation. Multivariable regression models were used to estimate associations with severe immunodeficiency.
RESULTS: The cohort included 1,815 children with CD4 data at enrollment and 1,922 at ART initiation. The proportion of children with severe immunodeficiency decreased over time: 20% at enrollment into care in Period 1 vs. 16% in Period 3 (p=0.113), and 21% at ART start in Period 1 vs. 15% in Period 3 (p=0.004). Children initiating ART in Period 3 had lower odds of severe immunodeficiency at ART start compared to those in Period 1 (aOR=0.67; 95%CI:0.51-0.88). Older age was associated with severe immunodeficiency at enrollment (aOR=1.13; 95%CI:1.06-1.20) and at ART initiation (aOR=1.14; 95%CI:1.08-1.21).
CONCLUSIONS: The proportion of children with severe immunodeficiency at ART initiation decreased alongside more inclusive ART initiation guidelines. Earlier treatment of CLHIV is imperative.
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