Long-term non-progression and risk factors for disease progression among children living with HIV in Botswana and Uganda: a retrospective cohort study.

We utilize a large retrospective study cohort derived from electronic medical records (EMR) 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. EMRs 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-ART era. Between the two countries, 14,246 ART-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 (aHR 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 enrolment into care, and country of origin are independent predictors of progression among children.

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Declaration of Competing Interest The author reports no financial or non-financial conflicts of interest in this work.