Retrospective cohort analysis of survival of children living with HIV/AIDS in Mumbai, India

ObjectivesTo understand the survival in a cohort of children living with HIV/AIDS (CLHAs) and to study the factors associated with survival in CLHAs in government antiretroviral therapy (ART) centres in Mumbai, India.DesignThis is a retrospective cohort analysis.SettingData from electronic ART records of children from 15 ART centres in Mumbai, Maharashtra, India.Participants2224 CLHAs registered in one of these ART centres from 2004 until October 2019. CLHAs up to the age of 18 at the time of registration were considered for these analyses.Primary and secondary outcomesWe accessed the following data: date of test, date of initiation of ART, date of last follow-up, age at the time of registration, gender, potential route of infection, baseline CD4 counts, ART regimen, adherence and presence of co-infection (TB). We estimated the survival probabilities, plotted the Kaplan-Meier survival graphs and estimated HRs for mortality.ResultsThe mortality rate in our population was 22.75 (95% CI 20.02 to 25.85) per 1000 person-years. The 1-year survival was 0.92 (95% CI 0.91 to 0.93), 0.89 (95% CI 0.88 to 0.91) at 5 years and 0.85 (95% CI 0.83 to 0.87) at 10 years after initiation of ART. Children with adherence less than 80% had lowest survival in the first year (0.54, 95% CI 0.46 to 0.61). It reduced drastically at 5 and 10 years. After adjusting for demographic and clinical parameters, mortality was associated with poor adherence (<80%) (HR 11.70, 95% CI 8.82 to 15.53; p<0.001). However, CD4 counts of greater than 200 and age more than 1 year were protective.ConclusionsPoor adherence to ART and low CD4 counts were significantly associated with higher mortality. Adherence counselling should be an important component of CLHA monitoring in all ART centres. It is also important to identify children early in the infection and start ART medications appropriately.

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Survival of Children Living With HIV on Art in Zambia: A 13-Years Retrospective Cohort Analysis

Frontiers in Public Health ◽

10.3389/fpubh.2020.00096 ◽

2020 ◽

Vol 8 ◽

Author(s):

Tendai Munthali ◽

Charles Michelo ◽

Paul Mee ◽

Jim Todd

Keyword(s):

Retrospective Cohort ◽

Cohort Analysis ◽

Retrospective Cohort Analysis ◽

Living With Hiv

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Are Routine Postoperative Radiographs Necessary During the First Year After Posterior Spinal Fusion for Idiopathic Scoliosis? A Retrospective Cohort Analysis of Implant Failure and Surgery Revision Rates

Journal of Pediatric Orthopaedics ◽

10.1097/bpo.0000000000000219 ◽

2015 ◽

Vol 35 (1) ◽

pp. 33-38 ◽

Cited By ~ 8

Author(s):

Sumeet Garg ◽

Emily Kipper ◽

Jaren LaGreca ◽

Patrick Carry ◽

Mark Erickson

Keyword(s):

Idiopathic Scoliosis ◽

Spinal Fusion ◽

Retrospective Cohort ◽

Cohort Analysis ◽

Posterior Spinal Fusion ◽

Implant Failure ◽

First Year ◽

Retrospective Cohort Analysis

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Determinants of Viral Suppression Among Adolescents on Antiretroviral Therapy in Ehlanzeni District, South Africa: A Retrospective Cohort Analysis

10.21203/rs.3.rs-211283/v1 ◽

2021 ◽

Author(s):

Emeka Francis Okonji ◽

Brian Van Wyk ◽

Ferdinand C. Mukumbang ◽

Gail Hughes

Keyword(s):

South Africa ◽

Viral Load ◽

Antiretroviral Therapy ◽

Retrospective Cohort ◽

Viral Suppression ◽

Cohort Analysis ◽

Cd4 Count ◽

Second Line ◽

Retrospective Cohort Analysis ◽

Living With Hiv

Abstract Background Achieving undetectable viral loads is crucial for the reduction of HIV transmissions, AIDS related illnesses and death. Adolescents living with HIV on antiretroviral therapy (ART) have worse treatment adherence and lower viral suppression rates compared to adults. We report on the clinical factors associated with viral suppression among adolescents 10–19 years living with HIV in the Ehlanzeni district, Mpumalanga in South Africa. Methods A retrospective cohort analysis was conducted with 9,543 adolescents living with HIV, aged 10–19 years, who were enrolled in 136 ART clinics in the Ehlanzeni district. Clinical and immunological data were obtained from electronic medical records (Tier.net). Adolescents were categorized as having achieved viral suppression if their latest viral load count was < 1000 ribonucleic acid (RNA) copies/mL. Using a backward stepwise approach, a multivariate logistic regression analysis was performed to identify factors independently associated with viral suppression. Results The mean age of the participants was 14.75 years (SD = 2.8), and 55.43% were female. Mean duration on ART was 72.26 (SD = 42.3) months. Of the 9,543 adolescents with viral load results recorded, 74% had achieved viral suppression. After adjusting for other covariates, the likelihood of achieving viral suppression remained significantly higher among adolescents who were: female (AOR = 1.21, 95% CI 1.05–1.38), had CD4 count > 200 (AOR = 2.29, 95% CI 1.89–2.79), and on ART for more than 6 months (AOR = 2.75, 95% CI 1.74–4.34). Furthermore, the likelihood of having viral suppression was lower among adolescents with CD4 count < 200 at baseline (AOR = 0.76, 95% CI 0.64–0.90), and who were switched to second line regimen (AOR = 0.42, 95% CI 0.35–0.49). Conclusions Viral suppression amongst adolescents at 74% is considerably lower than the WHO target of 90%. Of particular concern for intervention is the lower rates of viral suppression amongst male adolescents. Greater emphasis should be placed to enrol adolescents on ART earlier before CD4 counts are depleted (< 200) and keeping them engaged in care (beyond 6 months). Furthermore, improved viral load monitoring may prevent unnecessary switching to second line treatment, which are costly and is a risk factor for viral non suppression.

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Association of epilepsy and asthma: a population-based retrospective cohort study

PeerJ ◽

10.7717/peerj.4792 ◽

2018 ◽

Vol 6 ◽

pp. e4792 ◽

Cited By ~ 1

Author(s):

Kuo-Liang Chiang ◽

Fang-Chuan Kuo ◽

Jen-Yu Lee ◽

Chin-Yin Huang

Keyword(s):

Retrospective Cohort ◽

Cohort Analysis ◽

Population Based ◽

Control Group ◽

Research Database ◽

Asthma Incidence ◽

Kaplan Meier ◽

Retrospective Cohort Analysis ◽

Increased Risk ◽

Epilepsy Diagnosis

Background Epidemiologic data supporting the epilepsy–asthma association are insufficient. Therefore, we examined this association in this study. Methods By using claims data from the National Health Insurance Research Database (Taiwan), we executed a retrospective cohort analysis. Analysis 1 entailed comparing 150,827 patients diagnosed as having incident asthma during 1996–2013 with disease-free controls who were selected randomly during the same period, frequency matched in terms of age and sex. Similarly, analysis 2 entailed comparing 25,274 patients newly diagnosed as having epilepsy with sex- and age-matched controls who were selected randomly. At the end of 2013, we evaluated in analysis 1 the epilepsy incidence and risk and evaluated in analysis 2 the asthma incidence and risk. We applied Kaplan–Meier analysis to derive plots of the proportion of asthma-free seizures. Results In analysis 1, the asthma group exhibited a higher epilepsy incidence than did the control group (3.05 versus 2.26 per 1,000 person-years; adjusted hazard ratio: 1.39, 95% CI [1.33–1.45]). We also noted a greater risk of subsequent epilepsy in women and girls. In analysis 2, we determined that the asthma incidence between the control and epilepsy groups did not differ significantly; however, some age subgroups including children and individuals in their 30s had an increased risk. A negative association was found in adolescents. The Kaplan–Meier analysis revealed epilepsy to be positively associated with subsequent onset of asthma within seven years of epilepsy diagnosis. Discussion Asthma may be associated with high epilepsy risk, and epilepsy may be associated with high asthma risk among children and individuals in their 30s. Nevertheless, people with epilepsy in other age subgroups should be aware of the possibility of developing asthma within seven years of epilepsy diagnosis.

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