1. PROGRESSION OF HIV/AIDS IN CHILDREN ATTENDING AMPATH CLINICS IN W/KENYA Prof. Ayaya SO, Dr Nyandiko WM Dr Vreeman RC, Prof. Rotich JK IeDEA PI meeting, Zanzibar

2. BACKGROUND AMPATH - 10YRS Incubation period AIDS Survival Time Impact of AMPATH

3. OBJECTIVES Determine the incubation period and its associated factors Determine AIDS Survival Time and its associated factors

4. METHODOLOGY Study subjects : HIV infected children aged 14 yrs and below Setting: AMPATH clinics in WESTERN Kenya Design : retrospective analysis of prospectively collected data Analysis : regression analysis and Kaplan Meier Survival Curves

5. RESULTS I Demographic data Total of 5792 children included Age ≤ 2 yrs 1093 (19%) Female sex 2954 (51%) Ever on ARVs 3232 (56%) Orphans 1702 (29.39%)

6. RESULTS II AT ENROLMENT: HAZ severe (<3SD) 1230 (33.27%) WAZ severe(<3SD) 808 (21.64%) CDC class C 1134(19.92%) AIDS 3630(62.67%)

7. RESULTS III ADHERENCE Perfect ARV adherence 2271(68.82%) Perfect clinic adherence 1435(26.34%)

8. RESULTS IV OUTCOMES Time from diagnosis to ADE : Mean 217 days Median 112 days Time from ADE to death/LTFU Mean 201 DAYS Median 117 days

9. RESULTS V Factors associated with incubation period(HIV to ADE) AGE ≤ 2 YRS CDC stage at diagnosis (HR=1.8, CI 1.05-2.45) Non-clinic adherence (HR=0.9, CI 1.05-2.45) Never on ARV (HR=.41, CI 0.27-0.62)

10. RESULTS VI FACTORS ASSOCIATED WITH HIV TO ADE > 2 YRS CD4% at diagnosis (HR=0.9, CI.93-.95) CDC stage C at diagnosis(HR=5.4, CI 3.98-7.22) Non MTRH CLINIC (hr=.8, CI.66-.94) Never on ARV (HR=.36, CI.29-.66)

11. RESULTS VII Factors associated with HIV to ADE age ≤ 2 yrs CD 4% at diagnosis CDC at diagnosis Non-clinic adherence(HR=1.6, CI 1.05-2.45) Never on ARV (HR=0.41, CI.27-.62)

12. RESULTS VIII FACTORS ASSOCIATED WITH AIDS SURVIVAL TIME (age ≤ 2 yrs) Nearest CD4 at ADE ) EVER ON ARV )(HR=9.2, CI 3.9-21.1)

13. RESULTS IX FACTORS ASSOCIATED WITH AIDS SURVIVAL TIME (age ≥ 2yrs) Nearest CD 4 at ADE) ( HR=7.3, CI 4.1-13) Ever on ARV )

14. CONCLUSIONS I Incubation period was short AIDS survival time was short Factors associated with incubation period were: CDC stage at diagnosis Non- clinic adherence never on ARV

15. CONCLUSIONS II CD 4% Non MTRH clinic Factors associated with AIDS Survival time were: Nearest CD4 to ADE Ever on ARV

16. ACKNOWLEDGEMENTS Dean SOM MU Dean IUMC USAID-AMPATH MU-IU PRWG IEDEA EA JOE MAMLIN