International Journal of Infectious Diseases (Feb 2024)
Long-term non-progression and risk factors for disease progression among children living with HIV in Botswana and Uganda: A retrospective cohort study
- Samuel Kyobe,
- Grace Kisitu,
- Savannah Mwesigwa,
- John Farirai,
- Eric Katagirya,
- Gaone Retshabile,
- Lesedi Williams,
- Angela Mirembe,
- Lesego Ketumile,
- Misaki Wayengera,
- John Mukisa,
- Gaseene Sebetso,
- Thabo Diphoko,
- Marion Amujal,
- Edgar Kigozi,
- Fred Katabazi,
- Ronald Oceng,
- Busisiwe Mlotshwa,
- Koketso Morapedi,
- Betty Nsangi,
- Edward Wampande,
- Masego Tsimako,
- Chester Brown,
- Ishmael Kasvosve,
- Moses Joloba,
- Gabriel Anabwani,
- Sununguko Mpoloka,
- Graeme Mardon,
- Adeodata Kekitiinwa,
- Neil A. Hanchard,
- Jacqueline Kyosiimire–Lugemwa,
- Mogomotsi Matshaba,
- Dithan Kiragga
Affiliations
- Samuel Kyobe
- Department of Medical Microbiology, College of Health Sciences, Makerere University, Kampala, Uganda; Corresponding author:
- Grace Kisitu
- Baylor College of Medicine Children's Foundation Uganda, Kampala, Uganda
- Savannah Mwesigwa
- Department of Medical Microbiology, College of Health Sciences, Makerere University, Kampala, Uganda
- John Farirai
- Botswana-Baylor Children's Clinical Centre of Excellence, Gaborone, Botswana
- Eric Katagirya
- Department of Immunology and Molecular Biology, College of Health Sciences, Makerere University, Kampala, Uganda
- Gaone Retshabile
- Department of Biological Sciences, University of Botswana, Gaborone, Botswana
- Lesedi Williams
- Department of Biological Sciences, University of Botswana, Gaborone, Botswana
- Angela Mirembe
- Baylor College of Medicine Children's Foundation Uganda, Kampala, Uganda
- Lesego Ketumile
- Botswana-Baylor Children's Clinical Centre of Excellence, Gaborone, Botswana
- Misaki Wayengera
- Department of Immunology and Molecular Biology, College of Health Sciences, Makerere University, Kampala, Uganda
- John Mukisa
- Department of Immunology and Molecular Biology, College of Health Sciences, Makerere University, Kampala, Uganda
- Gaseene Sebetso
- Department of Biological Sciences, University of Botswana, Gaborone, Botswana
- Thabo Diphoko
- Department of Biological Sciences, University of Botswana, Gaborone, Botswana
- Marion Amujal
- Department of Immunology and Molecular Biology, College of Health Sciences, Makerere University, Kampala, Uganda
- Edgar Kigozi
- Department of Immunology and Molecular Biology, College of Health Sciences, Makerere University, Kampala, Uganda
- Fred Katabazi
- Department of Immunology and Molecular Biology, College of Health Sciences, Makerere University, Kampala, Uganda
- Ronald Oceng
- Baylor College of Medicine Children's Foundation Uganda, Kampala, Uganda
- Busisiwe Mlotshwa
- Department of Biological Sciences, University of Botswana, Gaborone, Botswana
- Koketso Morapedi
- Department of Biological Sciences, University of Botswana, Gaborone, Botswana
- Betty Nsangi
- Baylor College of Medicine Children's Foundation Uganda, Kampala, Uganda
- Edward Wampande
- Department of Immunology and Molecular Biology, College of Health Sciences, Makerere University, Kampala, Uganda
- Masego Tsimako
- Australian Medical Research, Hurstville, Australia
- Chester Brown
- University of Tennessee Health Science Center, Memphis, USA
- Ishmael Kasvosve
- School of Allied Health Professionals, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
- Moses Joloba
- Department of Immunology and Molecular Biology, College of Health Sciences, Makerere University, Kampala, Uganda
- Gabriel Anabwani
- Baylor College of Medicine Children's Foundation Uganda, Kampala, Uganda
- Sununguko Mpoloka
- Department of Biological Sciences, University of Botswana, Gaborone, Botswana
- Graeme Mardon
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, USA; Department of Pathology and Immunology, Baylor College of Medicine, Houston, USA
- Adeodata Kekitiinwa
- Baylor College of Medicine Children's Foundation Uganda, Kampala, Uganda; Pediatric Retrovirology, Department of Pediatrics, Baylor College of Medicine, Houston, USA
- Neil A. Hanchard
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, USA; USDA/ARS/Children's Nutrition Research Center, Baylor College of Medicine, Houston, USA; Childhood Complex Disease Genomics Section, Center for Precision Health Research, National Human Genome Research Institute, National Institutes of Health, Bethesda, USA
- Jacqueline Kyosiimire–Lugemwa
- Uganda Virus Research Institute, Entebbe, Uganda
- Mogomotsi Matshaba
- Botswana-Baylor Children's Clinical Centre of Excellence, Gaborone, Botswana; Pediatric Retrovirology, Department of Pediatrics, Baylor College of Medicine, Houston, USA
- Dithan Kiragga
- Baylor College of Medicine Children's Foundation Uganda, Kampala, Uganda; Pediatric Retrovirology, Department of Pediatrics, Baylor College of Medicine, Houston, USA
- Journal volume & issue
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Vol. 139
pp. 132 – 140
Abstract
Objectives: We utilize a large retrospective study cohort derived from electronic medical records to estimate the prevalence of long-term non-progression (LTNP) and determine the factors associated with progression among children infected with HIV in Botswana and Uganda. Methods: Electronic medical records from large tertiary HIV clinical centers in Botswana and Uganda were queried to identify LTNP children 0-18 years enrolled between June 2003 and May 2014 and extract demographic and nutritional parameters. Multivariate subdistribution hazard analyses were used to examine demographic factors and nutritional status in progression in the pre-antiretroviral therapy era. Results: Between the two countries, 14,246 antiretroviral therapy-naïve children infected with HIV were enrolled into clinical care. The overall proportion of LTNP was 6.3% (9.5% in Botswana vs 5.9% in Uganda). The median progression-free survival for the cohort was 6.3 years, although this was lower in Botswana than in Uganda (6.6 vs 8.8 years; P <0.001). At baseline, the adjusted subdistribution hazard ratio (aHRsd) of progression was increased among underweight children (aHRsd 1.42; 95% confidence interval [CI]: 1.32-1.53), enrolled after 2010 (aHRsd 1.32; 95% CI 1.22-1.42), and those from Botswana (aHRsd 2; 95% CI 1.91-2.10). Conclusions: In our study, the prevalence of pediatric LTNP was lower than that observed among adult populations, but progression-free survival was higher than expected. Underweight, year of enrollment into care, and country of origin are independent predictors of progression among children.
