In The News: Very Young Children in HIV Treatment More Likely to Die

Medpage Today reports on a CDC study finding children under five with HIV who received antiretroviral treatment (ART) died at percentages two to nine times higher than their older counterparts. The CDC’s Global Health Center and colleagues made specific note of outcomes related to the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). Among this group, 4.9% of children under one year of age receiving ART for HIV died over a two-year span, as did 2.5% of children aged one to four. Patients over age five had significantly better outcomes.

Children under five are less likely to receive an HIV diagnosis. Without a diagnosis, these children do not receive ART and have high mortality. Among children who do receive treatment, interruptions are common and viral load suppression less common. Authors of the Morbidity and Mortality Weekly Report pointed to this in stating mortality is likely underreported in this age group as health care professionals lose contact with those children during interruptions.

Treatment interruptions were defined as no clinical encounter within 28 days of prior scheduled clinical contact. Viral load suppression was defined by HIV RNA under 1,000 copies/mL documented in the last 12 months. Viral load suppression rates quoted in the story differed from those in the MMWR. The data were 78% and 73% for infants under one year of age and children one to four, respectively, compared with 66% (should be 85%) for children ages five-14 years and 85% in those ages 15-49 (should be 94%), and over 50 years of age was 96%.

Data were collected from PEPFAR treatment sites in 25 countries. The analysis period ran from October 2020 to September 2022 and included quarterly monitoring, evaluation and data analyzation.

The researchers suggest strategies that they say will have the potential to prevent death, reduce inequities experienced by children under five living with HIV, and contribute to global measures aimed at ending AIDS among children by 2030. They also noted that low-resource settings, including where PEPFAR countries and areas, general mortality for children under five is already high, and the contributing factors to that would also contribute to higher HIV mortality rates. 

PIDS member (and co-author of the recent JPIDS article on PEPFAR) Dorothy Dow commented on the story. “Published on World Aids Day, Dec 1, 2023, Agathis et al. wrote a compelling MMWR report highlighting the high rates of mortality among children under five years living with HIV, even when receiving antiretroviral therapy (ART).  This report features data from all clinical sites supported by the U.S. President’s Emergency Plan for AIDS (PEPFAR) and underscores the critical importance of the PEPFAR program to deliver powerful data sets on the measurement and evaluation of pediatric HIV care that would not otherwise be available, especially during the height of the COVID pandemic (Oct 2022-Sept2022).  The tools to improve survival in this population are known; however, stigma reduction and implementation science research that ‘let communities lead’ will be key to earlier child diagnosis, effective and sustained linkage to care, adherence support, and ultimately to achieve the goal of complete prevention of pediatric infections.”