Browsing by Author "Pinto J"

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    Access to antiretroviral therapy in HIV-infected children aged 0-19 years in the International Epidemiology Databases to Evaluate AIDS (IeDEA) Global Cohort Consortium, 2004-2015: A prospective cohort study.
    (2018-May) Desmonde S; Tanser F; Vreeman R; Takassi E; Edmonds A; Lumbiganon P; Pinto J; Malateste K; McGowan C; Kariminia A; Yotebieng M; Dicko F; Yiannoutsos C; Mubiana-Mbewe M; Wools-Kaloustian K; Davies MA; Leroy V; Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa.; Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, United States of America.; Inserm U1027, Toulouse III University, Toulouse, France.; Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.; Inserm U1219, University of Bordeaux, Bordeaux, France.; Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.; CHU Sylvanus Olympio, Lomé, Togo.; Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America.; Hopital Gabriel Touré, Bamako, Mali.; Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.; School of Medicine, Universide Federal de Minas Gerais, Belo Horizonte, Brazil.; School of Medicine, Indiana University, Indianapolis, Indiana, United States of America.; Bordeaux School of Public Health, University of Bordeaux, Bordeaux, France.; Khon Kaen University, Khon Kaen, Thailand.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; Division of Epidemiology, College of Public Health, Ohio State University, Columbus, Ohio, United States of America.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
    INTRODUCTION: Access to antiretroviral therapy (ART) is a global priority. However, the attrition across the continuum of care for HIV-infected children between their HIV diagnosis and ART initiation is not well known. We analyzed the time from enrollment into HIV care to ART initiation in HIV-infected children within the International Epidemiology Databases to Evaluate AIDS (IeDEA) Global Cohort Consortium. METHODS AND FINDINGS: We included 135,479 HIV-1-infected children, aged 0-19 years and ART-naïve at enrollment, between 1 January 2004 and 31 December 2015, in IeDEA cohorts from Central Africa (3 countries; n = 4,948), East Africa (3 countries; n = 22,827), West Africa (7 countries; n = 7,372), Southern Africa (6 countries; n = 93,799), Asia-Pacific (6 countries; n = 4,045), and Latin America (7 countries; n = 2,488). Follow-up in these cohorts is typically every 3-6 months. We described time to ART initiation and missed opportunities (death or loss to follow-up [LTFU]: last clinical visit >6 months) since baseline (the date of HIV diagnosis or, if unavailable, date of enrollment). Cumulative incidence functions (CIFs) for and determinants of ART initiation were computed, with death and LTFU as competing risks. Among the 135,479 children included, 99,404 (73.4%) initiated ART, 1.9% died, 1.4% were transferred out, and 20.4% were lost to follow-up before ART initiation. The 24-month CIF for ART initiation was 68.2% (95% CI: 67.9%-68.4%); it was lower in sub-Saharan Africa-ranging from 49.8% (95% CI: 48.4%-51.2%) in Central Africa to 72.5% (95% CI: 71.5%-73.5%) in West Africa-compared to Latin America (71.0%, 95% CI: 69.1%-72.7%) and the Asia-Pacific (78.3%, 95% CI: 76.9%-79.6%). Adolescents aged 15-19 years and infants <1 year had the lowest cumulative incidence of ART initiation compared to other ages: 62.2% (95% CI: 61.6%-62.8%) and 66.4% (95% CI: 65.7%-67.0%), respectively. Overall, 49.1% were ART-eligible per local guidelines at baseline, of whom 80.6% initiated ART. The following children had lower cumulative incidence of ART initiation: female children (p < 0.01); those aged <1 year, 2-4 years, 5-9 years, and 15-19 years (versus those aged 10-14 years, p < 0.01); those who became eligible during follow-up (versus eligible at enrollment, p < 0.01); and those receiving care in low-income or lower-middle-income countries (p < 0.01). The main limitations of our study include left truncation and survivor bias, caused by deaths of children prior to enrollment, and use of enrollment date as a proxy for missing data on date of HIV diagnosis, which could have led to underestimation of the time between HIV diagnosis and ART initiation. CONCLUSIONS: In this study, 68% of HIV-infected children initiated ART by 24 months. However, there was a substantial risk of LTFU before ART initiation, which may also represent undocumented mortality. In 2015, many obstacles to ART initiation remained, with substantial inequities. More effective and targeted interventions to improve access are needed to reach the target of treating 90% of HIV-infected children with ART.
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    Global Trends in CD4 Measurement and Immunosuppression at ART Initiation Among Children With HIV.
    (2025-Apr-04) Patten G; Malateste K; Bolton Moore C; Sipambo N; Mokone L; Anderegg N; Wools-Kaloustian K; Michael D; Odhiambo F; Kasozi C; Desmonde S; Amorissani-Folquet M; Leroy V; Kumara Wati D; Nallusamy R; Kinikar A; Quy DT; Yotebieng M; Ebasone PV; Lelo P; Pinto J; Rouzier V; Machado DM; Haw NJ; Ford N; Department of Pediatrics, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Udayana University, Bali, Indonesia.; School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.; Pediatric Department, Cocody University Hospital, Abidjan, Cote d'Ivoire.; Department of Medicine, Indiana University School of Medicine; Indianapolis, Indiana.; Department of Pediatrics, BJ Government Medical College and Sassoon General Hospital, Pune, India.; Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia.; Kalembe Lembe Pediatric Hospital, Kinshasa, Democratic Republic of the Congo.; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.; Clinical Research Education, Networking and Consultancy (CRENC), Yaoundé, Cameroon.; Department of Pediatrics, Escola Paulista de Medicina, Federal University of Sao Paulo (UNIFESP), São Paulo, Brazil.; Centres GHESKIO, Port-au-Prince, Haiti.; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.; SolidarMed, Maseru, Lesotho.; World Health Organization, Geneva, Switzerland.; Children's Hospital 1, Ho Chi Minh City, Vietnam.; University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Research Centre, Bordeaux, France.; Department of Paediatrics and Child Health, Harriet Shezi Children's Clinic, Chris Hani Baragwanath Academic Hospital, University of Witwatersrand, Johannesburg, South Africa.; From the Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa.; Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.; Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York.; Centre d'Epidémiologie et de Recherche en santé des POPulations (CERPOP), French National Institute for Health and Medical Research (Inserm), University of Toulouse 3, UMR 1295, Toulouse, France.; Department of Pediatrics, Penang Hospital, Penang, Malaysia.; Masaka Regional Referral Hospital, Masaka City, Uganda.; Tanzanian National Institute of Medical Research, Mwanza, Tanzania.
    Eligibility for antiretroviral therapy is no longer based on immune criteria. In a global cohort of 97,453 children, between 2005 and 2021, we observed large declines in CD4 measurement, from 51% to 12% among <5 seconds, and from 74% to 20% among those 5-14 years of age. Lack of CD4 testing may negatively affect clinical care and surveillance of severe immune suppression.
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    Growth and CD4 patterns of adolescents living with perinatally acquired HIV worldwide, a CIPHER cohort collaboration analysis.
    (2022-Mar) Jesson J; Crichton S; Quartagno M; Yotebieng M; Abrams EJ; Chokephaibulkit K; Le Coeur S; Aké-Assi MH; Patel K; Pinto J; Paul M; Vreeman R; Davies MA; Ben-Farhat J; Van Dyke R; Judd A; Mofenson L; Vicari M; Seage G; Bekker LG; Essajee S; Gibb D; Penazzato M; Collins IJ; Wools-Kaloustian K; Slogrove A; Powis K; Williams P; Matshaba M; Thahane L; Nyasulu P; Lukhele B; Mwita L; Kekitiinwa-Rukyalekere A; Wanless S; Goetghebuer T; Thorne C; Warszawski J; Galli L; van Rossum AMC; Giaquinto C; Marczynska M; Marques L; Prata F; Ene L; Okhonskaya L; Navarro M; Frick A; Naver L; Kahlert C; Volokha A; Chappell E; Pape JW; Rouzier V; Marcelin A; Succi R; Sohn AH; Kariminia A; Edmonds A; Lelo P; Lyamuya R; Ogalo EA; Odhiambo FA; Haas AD; Bolton C; Muhairwe J; Tweya H; Sylla M; D'Almeida M; Renner L; Abzug MJ; Oleske J; Purswani M; Teasdale C; Nuwagaba-Biribonwoha H; Goodall R; Leroy V; Baylor College of Medicine Children's Foundation, Mbabane, eSwatini.; University Hospital Yopougon, Abidjan, Côte d'Ivoire.; Siriraj Institute of Clinical Research, Faculty of Medicine Siriraj Hospital, Mahidol University, Salaya, Thailand.; Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.; Pediatric Hospital Kalembe Lembe, Lingwala, Demogratic Republic of Congo.; Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA.; Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.; Department of Pediatrics, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.; CHU Gabriel Toure, Bamako, Mali.; Hospital de Santa Maria, Lisboa, Portugal.; Hospital Universitari Vall d' Hebron, Vall d' Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain.; Baylor College of Medicine Children's Foundation, Kampala, Uganda.; Baylor International Pediatric AIDS Initiative, Texas Children's Hospital-USA, Houston, Texas, USA.; Hospital St Pierre, Brussels, Belgium.; Centro Hospitalar do Porto, Porto, Portugal.; Baylor College of Medicine Children's Foundation, Lilongwe, Botswana.; Republican Hospital of Infectious Diseases, St Petersburg, Russian Federation.; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.; MRC Clinical Trials Unit, University College London, London, UK.; Moi Teaching and Referral Hospital, Eldoret, Kenya.; Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA.; Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, USA.; Medical University of Warsaw, Hospital of Infectious Diseases in Warsaw, Warsaw, Poland.; Korle Bu Teaching Hospital, Accra, Ghana.; Institut de Recherche pour le Developpement (IRD), UMI-174/PHPT, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand.; Epicentre, Médecins Sans Frontières, Paris, France.; Tulane University Health Sciences Center, New Orleans, Louisiana, USA.; Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.; Institut National d'Etude Demographique (INED), Mortality, Health and Epidemiology Unit, Paris, France.; Department of Health Sciences, University of Florence, Florence, Italy.; CERPOP, Inserm, Université Paul Sabatier Toulouse 3, Toulouse, France.; Lighthouse Trust Clinic, Lilongwe, Malawi.; Padova University/PENTA Foundation, Padua, Italy.; University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, USA.; Children's Hospital of Eastern Switzerland, Saint Gallen, Switzerland.; Shupyk National Medical Academy of Postgraduate Education, Kiev, Ukraine.; TREAT Asia/amfAR, Bangkok, Thailand.; Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.; Morogoro Regional Hospital, Morogoro, Tanzania.; SolidarMed, Lesotho, Zimbabwe.; Department of Global Health, Icahn School of Medicine at Mount Sinai, New York, USA.; Baylor College of Medicine Children's Foundation, Mwanza, Tanzania.; Victor Babes Hospital, Bucharest, Romania.; Bronx-Lebanon Hospital Center, Bronx, New York, USA.; UNICEF, New York, USA.; Department of Paediatrics & Child Health, Faculty of Medicine & Health Sciences, Stellenbosch University, Worcester, South Africa.; Centre National Hospitalier Universitaire Hubert K. Maga, Cotonou, Benin.; International AIDS Society, Geneva, Switzerland.; School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.; Rutgers - New Jersey Medical School, Newark, New Jersey, USA.; Infection Disease Unit, Meyer Children's University Hospital, Florence, Italy.; Inserm U1018, Centre de recherche en Epidémiologie et Santé des Populations, Paris, France.; Erasmus MC University Medical Center Rotterdam-Sophia Children's Hospital, Rotterdam, The Netherlands.; Universidade Federal de Sao Paulo, Sao Paulo, Brazil.; Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa.; HIV Department, World Health Organization, Geneva, Switzerland.; GHESKIO Center, Port-au-Prince, Haiti.; UCL Great Ormond Street Institute of Child Health, University College London, London, UK.; Baylor College of Medicine Children's Foundation, Maseru, Lesotho.; ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, USA.; Indiana University School of Medicine, Indianapolis, Indiana, USA.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; Hospital General Universitario "Gregorio Marañón", Madrid, Spain.; Baylor College of Medicine Children's Foundation, Lilongwe, Malawi.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
    INTRODUCTION: Adolescents living with HIV are subject to multiple co-morbidities, including growth retardation and immunodeficiency. We describe growth and CD4 evolution during adolescence using data from the Collaborative Initiative for Paediatric HIV Education and Research (CIPHER) global project. METHODS: Data were collected between 1994 and 2015 from 11 CIPHER networks worldwide. Adolescents with perinatally acquired HIV infection (APH) who initiated antiretroviral therapy (ART) before age 10 years, with at least one height or CD4 count measurement while aged 10-17 years, were included. Growth was measured using height-for-age Z-scores (HAZ, stunting if <-2 SD, WHO growth charts). Linear mixed-effects models were used to study the evolution of each outcome between ages 10 and 17. For growth, sex-specific models with fractional polynomials were used to model non-linear relationships for age at ART initiation, HAZ at age 10 and time, defined as current age from 10 to 17 years of age. RESULTS: A total of 20,939 and 19,557 APH were included for the growth and CD4 analyses, respectively. Half were females, two-thirds lived in East and Southern Africa, and median age at ART initiation ranged from <3 years in North America and Europe to >7 years in sub-Saharan African regions. At age 10, stunting ranged from 6% in North America and Europe to 39% in the Asia-Pacific; 19% overall had CD4 counts <500 cells/mm CONCLUSIONS: Growth patterns during adolescence differed substantially by sex and region, while CD4 patterns were similar, with an observed CD4 decline that needs further investigation. Early diagnosis and timely initiation of treatment in early childhood to prevent growth retardation and immunodeficiency are critical to improving APH growth and CD4 outcomes by the time they reach adulthood.
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    The epidemiology of adolescents living with perinatally acquired HIV: A cross-region global cohort analysis.
    (2018-Mar) Slogrove AL; Schomaker M; Davies MA; Williams P; Balkan S; Ben-Farhat J; Calles N; Chokephaibulkit K; Duff C; Eboua TF; Kekitiinwa-Rukyalekere A; Maxwell N; Pinto J; Seage G; Teasdale CA; Wanless S; Warszawski J; Wools-Kaloustian K; Yotebieng M; Timmerman V; Collins IJ; Goodall R; Smith C; Patel K; Paul M; Gibb D; Vreeman R; Abrams EJ; Hazra R; Van Dyke R; Bekker LG; Mofenson L; Vicari M; Essajee S; Penazzato M; Anabwani G; Q Mohapi E; N Kazembe P; Hlatshwayo M; Lumumba M; Goetghebuer T; Thorne C; Galli L; van Rossum A; Giaquinto C; Marczynska M; Marques L; Prata F; Ene L; Okhonskaia L; Rojo P; Fortuny C; Naver L; Rudin C; Le Coeur S; Volokha A; Rouzier V; Succi R; Sohn A; Kariminia A; Edmonds A; Lelo P; Ayaya S; Ongwen P; Jefferys LF; Phiri S; Mubiana-Mbewe M; Sawry S; Renner L; Sylla M; Abzug MJ; Levin M; Oleske J; Chernoff M; Traite S; Purswani M; Chadwick EG; Judd A; Leroy V; Bronx-Lebanon Hospital Center (Icahn School of Medicine at Mount Sinai), Bronx, New York, United States of America.; National Institute of Child Health and Human Development (NICHD), US National Institutes of Health, Rockville, Maryland, United States of America.; Institute of Child Health, University College London, London, United Kingdom.; UNICEF, New York, New York, United States of America.; Inserm (French Institute of Health and Medical Research), CESP UMR Villejuif, France.; School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.; University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, United States of America.; ICAP at Columbia University Mailman School of Public Health, New York, New York, United States of America.; Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America.; CHU Gabriel Touré, Bamako, Mali.; Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, United States of America.; Feinberg School of Medicine, Northwestern University, Evanston, Illinois, United States of America.; University Children's Hospital, Basel, Switzerland.; MRC Clinical Trials Unit at University College London, London, United Kingdom.; Centro Hospitalar do Porto, Porto, Portugal.; Republican Hospital of Infectious Diseases, St Petersburg, Russian Federation.; Rutgers New Jersey Medical School, Newark, New Jersey, United States of America.; Tulane University, New Orleans, Louisiana, United States of America.; Medical University of Warsaw, Hospital of Infectious Diseases in Warsaw, Warsaw, Poland.; Karolinska University Hospital, Stockholm, Sweden.; Yopougon University Hospital, University Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire.; Baylor International Pediatric AIDS Initiative, Kampala, Uganda.; Epicentre, Médecins Sans Frontières, Paris, France.; Indiana University School of Medicine, Indianapolis, Indiana, United States of America.; Center for Infectious Diseases Epidemiology and Research, University of Cape Town, Cape Town, South Africa.; College of Public Health, Ohio State University, Columbus, Ohio, United States of America.; Department of Health Sciences, University of Florence, Florence, Italy.; Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.; Lighthouse Trust Clinic, Lilongwe, Malawi.; World Health Organization, Geneva, Switzerland.; Inserm (French Institute of Health and Medical Research), UMR 1027 Université Toulouse 3, Toulouse, France.; Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.; Shupyk National Medical Academy of Postgraduate Education, Kiev, Ukraine.; TREAT Asia/amfAR, Bangkok, Thailand.; Baylor International Pediatric AIDS Initiative, Mbeya, Tanzania.; Hospital Doce de Octubre, Madrid, Spain.; Hospital de Santa Maria/CHLN, Lisbon, Portugal.; Baylor International Pediatric AIDS Initiative, Lilongwe, Malawi.; Baylor International Pediatric AIDS Initiative, Texas Children's Hospital-USA, Houston, Texas, United States of America.; Baylor International Pediatric AIDS Initiative, Mbabane, Swaziland.; Universidade Federal de São Paulo, São Paulo, Brazil.; Pediatric Hospital Kalembe Lembe, Lingwala, Kinshasa, Democratic Republic of Congo.; Family AIDS Care and Education Services, Kenya Medical Research Institute, Kisumu, Kenya.; Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.; International AIDS Society, Geneva, Switzerland.; Baylor International Pediatric AIDS Initiative, Maseru, Lesotho.; PENTA Foundation, Padova, Italy.; Center for Infectious Disease Research in Zambia, Lusaka, Zambia.; Hospital St Pierre Cohort, Bruxelles, Belgium.; Erasmus MC University Medical Center Rotterdam-Sophia Children's Hospital, Rotterdam, the Netherlands.; Institut National d'Etudes Démograhiques (Ined), F-75020 Paris, France.; Institut de Recherche pour le Développement (IRD) 174/PHPT, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand.; Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain.; SolidarMed Lesotho, Mozambique and Zimbabwe, Lucerne, Switzerland.; Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.; Harriet Shezi Children's Clinic, Chris Hani Baragwanath Hospital, Johannesburg, South Africa.; Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa.; GHESKIO Center, Port-au-Prince, Haiti.; Kirby Institute, UNSW, Sydney, Australia.; Victor Babes Hospital, Bucharest, Romania.; Baylor International Pediatric AIDS Initiative, Gaborone, Botswana.; University of Ghana School of Medicine and Dentistry, Accra, Ghana.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
    BACKGROUND: Globally, the population of adolescents living with perinatally acquired HIV (APHs) continues to expand. In this study, we pooled data from observational pediatric HIV cohorts and cohort networks, allowing comparisons of adolescents with perinatally acquired HIV in "real-life" settings across multiple regions. We describe the geographic and temporal characteristics and mortality outcomes of APHs across multiple regions, including South America and the Caribbean, North America, Europe, sub-Saharan Africa, and South and Southeast Asia. METHODS AND FINDINGS: Through the Collaborative Initiative for Paediatric HIV Education and Research (CIPHER), individual retrospective longitudinal data from 12 cohort networks were pooled. All children infected with HIV who entered care before age 10 years, were not known to have horizontally acquired HIV, and were followed up beyond age 10 years were included in this analysis conducted from May 2016 to January 2017. Our primary analysis describes patient and treatment characteristics of APHs at key time points, including first HIV-associated clinic visit, antiretroviral therapy (ART) start, age 10 years, and last visit, and compares these characteristics by geographic region, country income group (CIG), and birth period. Our secondary analysis describes mortality, transfer out, and lost to follow-up (LTFU) as outcomes at age 15 years, using competing risk analysis. Among the 38,187 APHs included, 51% were female, 79% were from sub-Saharan Africa and 65% lived in low-income countries. APHs from 51 countries were included (Europe: 14 countries and 3,054 APHs; North America: 1 country and 1,032 APHs; South America and the Caribbean: 4 countries and 903 APHs; South and Southeast Asia: 7 countries and 2,902 APHs; sub-Saharan Africa, 25 countries and 30,296 APHs). Observation started as early as 1982 in Europe and 1996 in sub-Saharan Africa, and continued until at least 2014 in all regions. The median (interquartile range [IQR]) duration of adolescent follow-up was 3.1 (1.5-5.2) years for the total cohort and 6.4 (3.6-8.0) years in Europe, 3.7 (2.0-5.4) years in North America, 2.5 (1.2-4.4) years in South and Southeast Asia, 5.0 (2.7-7.5) years in South America and the Caribbean, and 2.1 (0.9-3.8) years in sub-Saharan Africa. Median (IQR) age at first visit differed substantially by region, ranging from 0.7 (0.3-2.1) years in North America to 7.1 (5.3-8.6) years in sub-Saharan Africa. The median age at ART start varied from 0.9 (0.4-2.6) years in North America to 7.9 (6.0-9.3) years in sub-Saharan Africa. The cumulative incidence estimates (95% confidence interval [CI]) at age 15 years for mortality, transfers out, and LTFU for all APHs were 2.6% (2.4%-2.8%), 15.6% (15.1%-16.0%), and 11.3% (10.9%-11.8%), respectively. Mortality was lowest in Europe (0.8% [0.5%-1.1%]) and highest in South America and the Caribbean (4.4% [3.1%-6.1%]). However, LTFU was lowest in South America and the Caribbean (4.8% [3.4%-6.7%]) and highest in sub-Saharan Africa (13.2% [12.6%-13.7%]). Study limitations include the high LTFU rate in sub-Saharan Africa, which could have affected the comparison of mortality across regions; inclusion of data only for APHs receiving ART from some countries; and unavailability of data from high-burden countries such as Nigeria. CONCLUSION: To our knowledge, our study represents the largest multiregional epidemiological analysis of APHs. Despite probable under-ascertained mortality, mortality in APHs remains substantially higher in sub-Saharan Africa, South and Southeast Asia, and South America and the Caribbean than in Europe. Collaborations such as CIPHER enable us to monitor current global temporal trends in outcomes over time to inform appropriate policy responses.