Background:  The KIDS-ART-LINC cohort collaboration was established in 2005-2006 to evaluate ART response of HIV-infected children including individual patient and program variables in Sub-Saharan Africa.
Methods:  We studied the 1-year survival after ART initiation in children aged ≤15 years, followed-up in 11 of the 25 participating clinical centers (agreed to participate, submitted local IRB approval, and computerized data system). We estimated the mortality from all causes in the first year, overall and stratified by age at ART initiation (≤18, 19 to 59, and ³60 months) and by baseline CD4 2006 WHO criteria for severe immunodeficiency (CD4 percentage <25, 20, 15 and 15 or CD4 count <1500, 750, 350, and 200 cells/mm³ for ages ≤11, 12 to 35, 36 to 59, and ³60 months, respectively). Kaplan-Meier survival estimates were plotted with their 95% confidence interval (CI) and Wald tests performed.

Results:  As of October 1, 2006, data were available for 795 patients from 4 clinical centers:  Tygerberg Children’s Hospital, South Africa (n = 508), Connaught Clinic, Zimbabwe (n = 154), Korle Bu Hospital, Ghana (n = 122), and MRC, The Gambia (n = 11). Characteristics at ART initiation were as follows:  median age at ART initiation (interquartile range) 4.1 years (1.6 to 8.2); 23.5% ≤18 months; 50.6% female; advanced clinical HIV disease (WHO stages 3-4) in 66.4% (n = 286); severe immunodeficiency in 60.4% (n = 439). During 889 child-years of follow-up, 15 children were lost to follow-up and 40 died. The probability of survival at 1 year of treatment ranged from 82.4% (CI 74.7 to 87.9) to 97.3% (CI 94.1 to 98.8) and 97.4% (CI 94.4 to 98.8) in children aged ≤18, 19 to 59, and ³60 months, respectively (p <10^–4) (see the figure). It ranged from 88.7% (CI 83.6 to 92.3) in children with severe immunodeficiency to 97.4% (CI 93.1 to 99.1) (p = 0.0058).

Conclusions:  The 1-year survival estimates of African children starting ART in the KIDS-ART-LINC collaboration corroborate individual study reports on smaller cohorts. ART is still mainly initiated at advanced disease stage in African children. These preliminary data emphasize the need for early diagnosis of HIV-infection. The early institution of care and treatment plans for children could greatly improve the pediatric survival patterns in Sub-Saharan Africa. Analysis of larger data sets from as many as 11 clinical centers to be done by the end of 2006 will take into account inter-cohort heterogeneity to look at individual and center-level factors of survival on ART.