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Optimal time for initiating antiretroviral therapy (ART) in HIV-infected, treatment-naive children aged 2 to 5 years old

  1. Nandi Siegfried1,2,*,
  2. Mary-Ann Davies3,
  3. Martina Penazzato4,5,
  4. Lulu M Muhe4,
  5. Matthias Egger6

Editorial Group: Cochrane HIV/AIDS Group

Published Online: 10 OCT 2013

Assessed as up-to-date: 24 MAY 2013

DOI: 10.1002/14651858.CD010309.pub2


How to Cite

Siegfried N, Davies MA, Penazzato M, Muhe LM, Egger M. Optimal time for initiating antiretroviral therapy (ART) in HIV-infected, treatment-naive children aged 2 to 5 years old. Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD010309. DOI: 10.1002/14651858.CD010309.pub2.

Author Information

  1. 1

    University of Cape Town, Department of Psychiatry and Mental Health, Cape Town, South Africa

  2. 2

    University of California, San Francisco, Department of Epidemiology and Biostatistics, San Francisco, California, USA

  3. 3

    School of Public Health and Family Medicine, Centre for Infectious Disease Epidemiology and Research (CIDER), Cape Town, South Africa

  4. 4

    World Health Organization, Geneva, Switzerland

  5. 5

    MRC Clinical Trials Unit, London, UK

  6. 6

    Institute of Social and Preventive Medicine, Institute of Social Medicine, Bern, Switzerland

*Nandi Siegfried, Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA. nandi.siegfried@gmail.com.

Publication History

  1. Publication Status: New
  2. Published Online: 10 OCT 2013

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[Figure 1]
Figure 1. Study flow diagram of database yields using the RCT string
[Figure 2]
Figure 2. Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
[Figure 3]
Figure 3. Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
[Analysis 1.1]
Analysis 1.1. Comparison 1 IMMEDIATE versus DEFERRED initiation of ART all ages (RCT), Outcome 1 Death.
[Analysis 1.2]
Analysis 1.2. Comparison 1 IMMEDIATE versus DEFERRED initiation of ART all ages (RCT), Outcome 2 CDC Category C disease (number of children).
[Analysis 1.3]
Analysis 1.3. Comparison 1 IMMEDIATE versus DEFERRED initiation of ART all ages (RCT), Outcome 3 CDC Category B disease (numbers of children) Relative Risk.
[Analysis 1.4]
Analysis 1.4. Comparison 1 IMMEDIATE versus DEFERRED initiation of ART all ages (RCT), Outcome 4 CDC Category B disease (numbers of children) Peto Odds Ratio.
[Analysis 1.5]
Analysis 1.5. Comparison 1 IMMEDIATE versus DEFERRED initiation of ART all ages (RCT), Outcome 5 Pulmonary TB (clinically diagnosed).
[Analysis 1.6]
Analysis 1.6. Comparison 1 IMMEDIATE versus DEFERRED initiation of ART all ages (RCT), Outcome 6 Median time before development of CDC B or C event.
[Analysis 1.7]
Analysis 1.7. Comparison 1 IMMEDIATE versus DEFERRED initiation of ART all ages (RCT), Outcome 7 Proportion of children on ART with HIV-RNA < 50 copies/ml.
[Analysis 1.8]
Analysis 1.8. Comparison 1 IMMEDIATE versus DEFERRED initiation of ART all ages (RCT), Outcome 8 Median CD4% at study end.
[Analysis 1.9]
Analysis 1.9. Comparison 1 IMMEDIATE versus DEFERRED initiation of ART all ages (RCT), Outcome 9 Mean CD4% at week 144.
[Analysis 1.10]
Analysis 1.10. Comparison 1 IMMEDIATE versus DEFERRED initiation of ART all ages (RCT), Outcome 10 Proportion of children with CD4% < 15% at study end.
[Analysis 1.11]
Analysis 1.11. Comparison 1 IMMEDIATE versus DEFERRED initiation of ART all ages (RCT), Outcome 11 Mean weight gain per year in kg.
[Analysis 1.12]
Analysis 1.12. Comparison 1 IMMEDIATE versus DEFERRED initiation of ART all ages (RCT), Outcome 12 Median weight-for-age Z score at study end (134 - 144 weeks).
[Analysis 1.13]
Analysis 1.13. Comparison 1 IMMEDIATE versus DEFERRED initiation of ART all ages (RCT), Outcome 13 Mean height gain per year in cm.
[Analysis 1.14]
Analysis 1.14. Comparison 1 IMMEDIATE versus DEFERRED initiation of ART all ages (RCT), Outcome 14 Median height-for-age Z score at study end (134 - 144 weeks).
[Analysis 1.15]
Analysis 1.15. Comparison 1 IMMEDIATE versus DEFERRED initiation of ART all ages (RCT), Outcome 15 Mean standardized score on Beery VMI at 144 weeks.
[Analysis 1.16]
Analysis 1.16. Comparison 1 IMMEDIATE versus DEFERRED initiation of ART all ages (RCT), Outcome 16 Proportion of children with adverse events.
[Analysis 1.17]
Analysis 1.17. Comparison 1 IMMEDIATE versus DEFERRED initiation of ART all ages (RCT), Outcome 17 Proportion of children with ART-related adverse events.
[Analysis 2.1]
Analysis 2.1. Comparison 2 SUBGROUP ANALYSIS: IMMEDIATE versus DEFERRED initiation of ART 24 to 59 months (RCT), Outcome 1 Death.
[Analysis 2.2]
Analysis 2.2. Comparison 2 SUBGROUP ANALYSIS: IMMEDIATE versus DEFERRED initiation of ART 24 to 59 months (RCT), Outcome 2 CDC Category C disease (number of children).
[Analysis 2.3]
Analysis 2.3. Comparison 2 SUBGROUP ANALYSIS: IMMEDIATE versus DEFERRED initiation of ART 24 to 59 months (RCT), Outcome 3 CDC Category B disease (numbers of children) Relative Risk.
[Analysis 2.4]
Analysis 2.4. Comparison 2 SUBGROUP ANALYSIS: IMMEDIATE versus DEFERRED initiation of ART 24 to 59 months (RCT), Outcome 4 CDC Category B disease (numbers of children) Peto Odds Ratio.
[Analysis 2.5]
Analysis 2.5. Comparison 2 SUBGROUP ANALYSIS: IMMEDIATE versus DEFERRED initiation of ART 24 to 59 months (RCT), Outcome 5 Pulmonary TB (clinically diagnosed).
[Analysis 2.6]
Analysis 2.6. Comparison 2 SUBGROUP ANALYSIS: IMMEDIATE versus DEFERRED initiation of ART 24 to 59 months (RCT), Outcome 6 Proportion of children on ART with HIV-RNA < 50 copies/ml.
[Analysis 2.7]
Analysis 2.7. Comparison 2 SUBGROUP ANALYSIS: IMMEDIATE versus DEFERRED initiation of ART 24 to 59 months (RCT), Outcome 7 Mean CD4% at week 144.
[Analysis 2.8]
Analysis 2.8. Comparison 2 SUBGROUP ANALYSIS: IMMEDIATE versus DEFERRED initiation of ART 24 to 59 months (RCT), Outcome 8 Proportion of children with CD4% < 15% at study end.
[Analysis 2.9]
Analysis 2.9. Comparison 2 SUBGROUP ANALYSIS: IMMEDIATE versus DEFERRED initiation of ART 24 to 59 months (RCT), Outcome 9 Mean weight gain per year in kg.
[Analysis 2.10]
Analysis 2.10. Comparison 2 SUBGROUP ANALYSIS: IMMEDIATE versus DEFERRED initiation of ART 24 to 59 months (RCT), Outcome 10 Mean height gain per year in cm.
[Analysis 2.11]
Analysis 2.11. Comparison 2 SUBGROUP ANALYSIS: IMMEDIATE versus DEFERRED initiation of ART 24 to 59 months (RCT), Outcome 11 Mean standardized score on Beery VMI at 144 weeks.
[Analysis 2.12]
Analysis 2.12. Comparison 2 SUBGROUP ANALYSIS: IMMEDIATE versus DEFERRED initiation of ART 24 to 59 months (RCT), Outcome 12 Proportion of children with ART-related Grade 3 or 4 adverse events.
[Analysis 3.1]
Analysis 3.1. Comparison 3 ADJUSTED/WEIGHTED EARLY vs DEFERRED initiation of ART in children with TB and HIV, Outcome 1 Death.
[Analysis 3.2]
Analysis 3.2. Comparison 3 ADJUSTED/WEIGHTED EARLY vs DEFERRED initiation of ART in children with TB and HIV, Outcome 2 Virologic suppression.