Predictors of mortality in HIV-1 infected children on antiretroviral therapy in Kenya: a prospective cohort

Abstract

BackgroundAmong children, early mortality following highly active antiretroviral therapy (HAART) remains high. It is important to define correlates of mortality in order to improve outcome.MethodsHIV-1-infected children aged 18 months-12 years were followed up at Kenyatta National Hospital, Nairobi after initiating NNRTI-based HAART. Cofactors for mortality were determined using multivariate Cox regression models.ResultsBetween August 2004 and November 2008, 149 children were initiated on HAART of whom 135 were followed for a total of 238 child-years (median 21 months) after HAART initiation. Baseline median CD4% was 6.8% and median HIV-1-RNA was 5.98-log10 copies/ml. Twenty children (13.4%) died at a median of 35 days post-HAART initiation. Mortality during the entire follow-up period was 8.4 deaths per 100 child-years (46 deaths/100 child-years in first 4 months and 1.0 deaths/100 child-years after 4 months post-HAART initiation). On univariate Cox regression, baseline hemoglobin (Hb) <9 g/dl, weight-for-height z-score (WHZ) < -2, and WHO clinical stage 4 were associated with increased risk of death (Hb <9 g/dl HR 3.00 [95% C.I. 1.21-7.39], p = 0.02, WHZ < -2 HR 3.41 [95% C.I. 1.28-9.08], p = 0.01, and WHO clinical stage 4, HR 3.08 [1.17-8.12], p = 0.02). On multivariate analysis Hb < 9 g/dl remained predictive of mortality after controlling for age, baseline CD4%, WHO clinical stage and weight-for-height z-score (HR 2.95 (95% C.I. 1.04-8.35) p = 0.04).ConclusionHigh early mortality was observed in this cohort of Kenyan children receiving HAART, and low baseline hemoglobin was an independent risk factor for death.

Administração de medicamentos para crianças nascidas expostas ao vírus da imunodeficiência humana

“…(1) The AIDS epidemic in Brazil is complex and dynamic because it was first found to occur among homosexual men and, later, among people who received blood transfusions and those who used injection-type drugs. Nowadays, this disease is more prevalent among heterosexual men and women, with percentages of 43.4% and 96.3%, respectively.…”

“…As a result, the numbers of infected children, cases of pneumonia, and cases of other comorbidities have grown. (1,7,8) AZT and TMP-SMZ administration for HIV-exposed children is a challenge because it is done at home and depends on the mother or other caregiver, who must be advised about the therapeutic regimen. Considering the relevance of this topic, this study evaluated the ability of HIV-positive mothers to administer AZT syrup and TMP-SMZ prophylaxis to their newborns exposed to maternal HIV infection.…”

Mortality and Clinical Outcomes in HIV-Infected Children on Antiretroviral Therapy in Malawi, Lesotho, and Swaziland

“…This is lower than reported rates from another regional pediatric cohort from Kenya between August 2004 and November 2008 which had a mortality rate of 8.4 deaths/100 person-years (95% CI 5.21-12.68). 8 This Kenyan cohort was older at ART…”

“…This has been reported previously in both adult and pediatric populations. 8,11,15,29,30 The advanced immunosuppression and clinical disease often associated with early mortality on ARTreinforce the need for programmatic emphasis on earlier diagnosis, enrollment in care, and initiation of ART.…”

“…1 Evidence from both developed and developing countries demonstrates that antiretroviral therapy (ART) can reduce mortality in HIV-infected adults and children. [2][3][4][5][6][7][8][9][10][11][12][13][14][15] However, as of 2010, only 21% of eligible African children accessed ART despite scaling up of HIV services, and most national ART programs in the region are not meeting the World Health Organization (WHO) goal that infants and children represent at least 10% to 15% of all patients on ART. 1,16 Althoughmuch work remains toimprove ART access for HIV-infected African children, notable regional progress has been made in the past decade.…”