Incidence and risk factors of loss to follow-up among HIV-infected children in an antiretroviral treatment program


Autoři: Suttipong Kawilapat aff001;  Nicolas Salvadori aff001;  Nicole Ngo-Giang-Huong aff001;  Luc Decker aff001;  Suparat Kanjanavanit aff005;  Achara Puangsombat aff006;  Kanchana Preedisripipat aff007;  Narong Lertpienthum aff008;  Noppadon Akarathum aff009;  Jutarat Mekmullica aff010;  Ussanee Srirompotong aff011;  Marc Lallemant aff001;  Sophie Le Coeur aff001;  Patrinee Traisathit aff001;  Charline Leroi aff001;  Gonzague Jourdain aff001
Působiště autorů: Institut de recherche pour le développement (IRD, France), U174 –PHPT, Chiang Mai, Thailand aff001;  Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand aff002;  Graduate Program in Applied Statistics, Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand aff003;  Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America aff004;  Nakornping Hospital, Chiang Mai, Thailand aff005;  Samutprakarn Hospital, Samutprakarn, Thailand aff006;  Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand aff007;  Buddhachinaraj Hospital, Phitsanulok, Thailand aff008;  Sanpatong Hospital, Chiang Mai, Thailand aff009;  Bhumibol Adulyadej Hospital, Bangkok, Thailand aff010;  Khon Kaen Hospital, Khon Kaen, Thailand aff011;  Institut National d'Etudes Démographiques (INED), Paris, France aff012;  Data Science Research Center, Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand aff013
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0222082

Souhrn

Introduction

The success of antiretroviral treatment (ART) programs can be compromised by high rates of patient loss to follow-up (LTFU). We assessed the incidence and risk factors of LTFU in a large cohort of HIV-infected children receiving ART in Thailand.

Methods

All children participating in a multicenter cohort (NCT00433030) between 1999 and 2014 were included. The date of LTFU was 9 months after the last contact date. ART interruption was defined as ART discontinuation for more than 7 days followed by resumption of treatment. Baseline and time-dependent risk factors associated with LTFU were identified using Fine and Gray competing risk regression models with death or referral to another hospital as competing events.

Results

Of 873 children who were followed during a median of 8.6 years (interquartile range 4.5–10.6), 196 were LTFU, 73 died, and 195 referred. The cumulative incidence of LTFU was 2.9% at 1 year, 7.3% at 5 years and 22.2% at 10 years. Children aged 13 years and more had a 3-fold higher risk (95% confidence interval 2.06–4.78) of LTFU than those younger. Children who had interrupted ART within the previous year had a 2.5-fold higher risk (1.12–5.91) than those who had not. The risk of LTFU was lower in children stunted (height-for-age Z-scores <-2 SD) (0.42–0.96) or underweight (weight-for-age Z-scores <-2 SD) (0.24–0.97).

Conclusion

Adolescence, ART interruption and absence of growth deficit were associated with LTFU. These may be warnings that should draw clinicians’ attention and possibly trigger specific interventions. Children with no significant growth retardation may also be at risk of LTFU.

Klíčová slova:

Biology and life sciences – Vaccination and immunization – Microbiology – Medical microbiology – Microbial pathogens – Viral pathogens – Immunodeficiency viruses – HIV – Retroviruses – Lentivirus – Microbial control – Antimicrobials – Virology – Antivirals – Antiretrovirals – Organisms – Viruses – RNA viruses – Anatomy – Body fluids – Blood – Blood counts – Physiology – Medicine and health sciences – Immunology – Public and occupational health – Preventive medicine – Antiviral therapy – Hematology – anémia – Epidemiology – Medical risk factors – Pathology and laboratory medicine – Pathogens – Pharmacology – Drugs – People and places – Population groupings – Age groups – Children – Families – Geographical locations – Asia – Thailand


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2019 Číslo 9
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