Predictors of Early Mortality in a Cohort of Human Immunodeficiency Virus Type 1-Infected African Children

Abstract

Background-Pediatric human immunodeficiency virus type 1 (HIV-1) infection follows a bimodal clinical course with rapid progression in 10 -45% of children before the age of 2 years and slower progression in the remainder. A prospective observational study was undertaken to determine predictors of mortality in HIV-1-infected African infants during the first 2 years of life.

Active tracking of rejected dried blood samples in a large program in Nigeria

“…However, the observed high rejection and low repeat rates in addition to the higher mean age of infants at the time of specimen recollection in this study suggest that sample rejection further delays HIV diagnosis in infants while emphasizing the importance of standardization and monitoring of pre-analytical variables [30] . Our study agrees with other investigations where pre-analytical [33][34][35]45] . Other adverse patient outcomes due to sample rejection include demand for patient revisits for specimen recollection, discomfort to the patient, test abandonment or LTFU and time lost in waiting for results with the accompanying cost implications associated with multiple clinic visits [22,46,47] .…”

“…Pre-analytical errors contribute an estimated 60%-70% of all mistakes in laboratory diagnostics and can render dried blood spots (DBS) untestable, leading to specimen rejection with a resultant negative impact on patients [29][30][31] . Common pre-analytical errors associated with DBS rejection include: Labeling errors, sample damage, missing or inconsistent data, and insufficient volume [32][33][34][35] . High risk for rapid disease progression and death necessitates the need for early identification and treatment of HIV positive infants [36] .…”

Implications of the new WHO guidelines on HIV and infant feeding for child survival in South Africa

“…This supports earlier findings from Kenya of increased early mortality among formula-fed infants. 8,9 However, in the MASHI study, by 18 months there were no significant differences between the formula-fed and breastfed plus ZDV group in the combined outcome of HIV infection or mortality (13.9% versus 15.1%; P = 0.60). Both strategies therefore resulted in comparable HIV-free survival at 18 months.…”

Obstetrical, maternal characteristics and outcome of HIV-infected rapid progressor infants at Yaounde: a retrospective study

“…It has been proven that there is a relationship between high maternal viral load and severe immunodeficiency, and high viral load in infants (15,(19)(20)(21)(22). The severity of immunosuppression, and high viral loads in infants (23)(24)(25) are associated with rapid progression of HIV infection. On the contrary, maternal treatment even with prophylactic regimen, would indirectly reduce the progression of the disease in the infant (15,16,19,26).…”