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Objectives We examined whether the timing of initiation of antiretroviral therapy (ART) in routine clinical practice reflected treatment guidelines, which have evolved towards recommending starting therapy at lower CD4 cell counts. Methods We analysed longitudinal data on 10 820 patients enrolled in the UK Collaborative HIV Cohort (UK CHIC) Study, which includes seven large clinical centres in south-east England. CD4 cell and viral load measurements performed in the period between 1 January 1997 and 31 December 2003 were classified according to whether ART was subsequently initiated or deferred, to estimate the probability of ART initiation by CD4 count and viral load over time. The effect of nonclinical factors (age, sex, ethnicity, and exposure category) was analysed by logistic regression. Kaplan–Meier analysis was used to estimate the proportion of patients who had initiated ART by a particular CD4 count among ‘early’ presenters (initial CD4 cell count >500 cells/μL). Results There was a tendency to initiate ART at lower CD4 cell counts over time in the years 1997–2000, especially in the range 200–500 cells/μL, with little change thereafter. An estimated 34% of HIV-infected individuals having presented early initiated ART at a CD4 count <200 cells/μL. We also found an independent influence of viral load, which was particularly pronounced for CD4 <350 cells/μL. Use of injection drugs was the only nonclinical factor associated with initiation of ART at lower CD4 cell counts. Conclusions The initiation of ART in the clinics included in this analysis reflected evolving treatment guidelines. However, an unexpectedly high proportion of patients started ART at lower CD4 counts than recommended, which is only partly explained by late presentation. [ABSTRACT FROM AUTHOR]

Considers the estimation of the rate of vertical human immunodeficiency virus transmission and the acquired immune deficiency syndrome incubation period using data from birth cohort studies. Possibility that standard method of analysis may lead to biased estimates; Acquisition of maximum likelihood estimates.

The relationships between nutritional status and 24 social and economic factors were investigated during the dry season and at the end of the rainy season in about 300 children aged 6 to 35 months living in the urban community of Bakau in The Gambia. Height‐for‐age was associated with the style of house and various other factors related to living conditions, the presence of the father in the compound and the parity of the mother. The associations were similar in both seasons. Weight‐for‐age showed similar, though weaker, associations in the rainy season, but there was little relationship between the socio‐economic factors and weight‐for‐age during the dry season. Few children had low weight‐for‐height in this community, and there was little relationship between weight‐for‐height and socio‐economic factors. This study emphasises the need to consider the effect of seasonal variations when assessing the relationship between nutritional status and socio‐economic factors. [ABSTRACT FROM PUBLISHER]

Abstract Objective: To describe changes in demographic factors, disease progression, hospital admissions, and use of antiretroviral therapy in children with HIV. Design: Active surveillance through the national study of HIV in pregnancy and childhood (NSHPC) and additional data from a subset of children in the collaborative HIV paediatric study (CHIPS). Setting: United Kingdom and Ireland. Participants: 944 children with perinatally acquired HIV-1 under clinical care. Main outcome measures: Changes over time in progression to AIDS and death, hospital admission rates, and use of antiretroviral therapy. Results: 944 children with perinatally acquired HIV were reported in the United Kingdom and Ireland by October 2002;628 (67%) were black African, 205 (22%) were aged ≥10 years at last follow up, 193 (20%) are know to have died. The proportion of children presenting who were born abroad increased from 20% in 1994-5 to 60% during 2000-2. Mortality was stable before 1997 at 9.3 per 100 child years at risk but fell to 2.0 in 2001-2 (trend P < 0.001). Progression to AIDS also declined (P < 0.001). From 1997 onwards the proportion of children on three or four drug antiretroviral therapy increased. Hospital admission rates declined by 80%, but with more children in follow up the absolute number of admissions fell by only 26%. Conclusion: In children with HIV infection, mortality, AIDS, and hospital admission rates have declined substantially since the introduction of three or four drug antiretroviral therapy in 1997. As infected children in the United Kingdom and Ireland are living longer, there is an increasing need to address their medical, social, and psychological needs as they enter adolescence and adult life. [ABSTRACT FROM AUTHOR]