A massive new global meta-analysis on pediatric HIV mortality reminds us of the critical importance of early diagnosis and treatment in this highly vulnerable patient population. That priority holds true even in wealthy nations such as the U.S., where we may be quick to assume that antiretroviral therapy (ART) initiation will obviate immediate health risks; as this study makes clear, starting treatment is only part of the equation (albeit a critical part).
Highlighted Study Population and Methods
The authors conducted a systematic review of studies that describe HIV-related mortality among children and adolescents on ART. Using data on mortality rate and key predictors such as age, duration of ART, region, calendar year, and immunologic status, study authors analyzed for change in mortality risk over time, and demographic factors were assessed and stratified by region, age categories, and treatment duration.
The meta-analysis, published online in Lancet HIV on Sept. 2, included data from 84 reports published between 2000 and 2020 about children and young adolescents living with HIV, age 0 to 15 years and receiving antiretroviral therapy from a wide range of countries, especially those in high-burden regions.
Key Findings
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Mortality rates among children and young adolescents on antiretroviral therapy have declined substantially over calendar time.
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In many settings, among children aged 5-14 years, mortality declined by ~50%+ between 1990 and 2016.
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Younger age groups—especially infants initiating ART—have much higher mortality than older children/adolescents.
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Mortality is highest in the first months after ART initiation; risk falls with longer duration on ART.
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Baseline CD4 is an important predictor of mortality. Children with lower baseline CD4 counts have about three times the mortality risk of those with higher CD4 counts.
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The declines and absolute mortality risk differ by region; some regions have not achieved high mortality reductions. For instance, some Asia–Pacific and Latin American countries have mortality rates for young children with low CD4 cell counts that are higher than those in sub-Saharan Africa.
Read an expert analysis from Benjamin Young, M.D., Ph.D. at TheBodyPro.