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Children with severe immunodeficiency need earlier ART

ATLANTA — A significant number of children with HIV who live in resource-limited settings begin antiretroviral therapy with severe immunodeficiency, especially among children aged younger than 12 months, according to findings presented here during the 2013 Conference on Retroviruses and Opportunistic Infections.

Kunjal Patel, DSc, MPH, research scientist in the department of epidemiology at Harvard School of Public Health, and colleagues conducted a study to determine the prevalence of severe immunodeficiency in children at the start of ART in low-, middle- and high-income countries, using the World Bank classification.

The study included children aged younger than 17 years with available CD4 measurement at the start of ART. Patients were recruited from a clinic or program that participated in one of five regions of the International Epidemiologic Databases to Evaluate AIDS, the Pediatric HIV/AIDS Cohort Study, and the International Maternal Pediatric Adolescent AIDS Clinical Trials (IMPAACT) 219C study.

Severe immunodeficiency was defined, according to WHO criteria, as CD4 percent less than 25% (aged younger than 11 months); less than 20% (aged 12 to 35 months); less than 15% (aged 36 to 59 months); and either CD4 count less than 200 cells/mcL or CD4 percent less than 15% in children aged older than 5 years.

More than 29,000 children with CD4 data from 29 countries were included in the analysis: 13 low-income countries; nine lower-middle income countries; five upper-middle income countries; and two high-income countries. The median number of children per country was 186 (interquartile range [IQR], 63-814), median age was 5 years (IQR, 2-9) and 49% were female.

The median year for the start of ART was 2007 (IQR, 2005-2008), with median CD4 count in children aged older than 5 years of 230 (IQR, 84-426) cells/mcL and median CD4 percent of 14% in children aged younger than 5 years.

Overall, 16,658 children (57%) had severe immunodeficiency, according to the researchers. The highest prevalence (64%) of children with severe immunodeficiency was in upper middle-income countries.

In all country categories except high income, children aged younger than 12 months had the highest prevalence of severe immunodeficiency (77% to 88%).

For more information:

Avila D. #940. Presented at: 2013 Conference on Retroviruses and Opportunistic Infections; March 3-6, 2013; Atlanta.

Disclosure: Patel reports no relevant financial disclosures.