부산대학교 도서관

BACKGROUND:: Among children in Southern Africa severe immune suppression (SIS) has declined, but the majority continue to initiate ART with SIS. SETTING:: Using data from South Africa, we describe SIS at ART start and on ART between 2007-2020, among children <5 years with a CD4%/cell count at ART start and ≥1 subsequent measure. METHODS:: Gap in care was defined as >9 months without a recorded visit. We defined SIS according to age and CD4%/cell count. A multistate model was used to estimate transition probabilities between 5 states: SIS on ART; Stable, not SIS; Early Gap, commencing <9 months from ART start; Late Gap, commencing ≥9 months on ART; and Death. RESULTS:: Among 2536 children, 70% had SIS at ART start, and 36% experienced SIS on ART. An increasing proportion were age <1 year at ART initiation (2007-2009: 43% to 2013-2020: 55%). Increasingly SIS on ART occurred following a gap, in those with SIS on ART for >1 year, and following a period of unknown immune status. Later year of ART initiation was associated with reduced transition from SIS on ART to Stable. Infants and those initiating ART with SIS were more likely to transition from Stable to SIS. Viraemia strongly predicted death from both the on ART states. CONCLUSIONS:: Increasingly SIS occurred among ART-experienced children. Those starting ART with SIS and during infancy remained especially vulnerable to SIS once on treatment. Managing ART in these children may be more complex and further reducing AIDS-related mortality is likely to remain challenging.