Risk Factors for Pre-Treatment Mortality among HIV-Infected Children in Rural Zambia: A Cohort Study

Abstract

BackgroundMany HIV-infected children in sub-Saharan Africa enter care at a late stage of disease. As preparation of the child and family for antiretroviral therapy (ART) can take several clinic visits, some children die prior to ART initiation. This study was undertaken to determine mortality rates and clinical predictors of mortality during the period prior to ART initiation.MethodsA prospective cohort study of HIV-infected treatment-naïve children was conducted between September 2007 and September 2010 at the HIV clinic at Macha Hospital in rural Southern Province, Zambia. HIV-infected children younger than 16 years of age who were treatment-naïve at study enrollment were eligible for analysis. Mortality rates prior to ART initiation were calculated and risk factors for mortality were evaluated.Results351 children were included in the study, of whom 210 (59.8%) were eligible for ART at study enrollment. Among children ineligible for ART at enrollment, 6 children died (mortality rate: 0.33; 95% CI:0.15, 0.74). Among children eligible at enrollment, 21 children died before initiation of ART and their mortality rate (2.73 per 100 person-years; 95% CI:1.78, 4.18) was significantly higher than among children ineligible for ART (incidence rate ratio: 8.20; 95% CI:3.20, 24.83). In both groups, mortality was highest in the first three months of follow-up. Factors associated with mortality included younger age, anemia and lower weight-for-age z-score at study enrollment.ConclusionsThese results underscore the need to increase efforts to identify HIV-infected children at an earlier age and stage of disease progression so they can enroll in HIV care and treatment programs prior to becoming eligible for ART and these deaths can be prevented.

Mortality in a Cohort of HIV-Infected Children: A 12-Month Outcome of Antiretroviral Therapy in Makurdi, Nigeria

“…Without ART, half of the HIV-infected children tend to die before their 2nd birthday [3–5]. The proportion of HIV deaths remains higher in resource-limited countries (RLCs) [6–13] compared to resource-rich countries (RRC) [14–16] because of pervasive weak health systems, poor socioeconomic conditions, and a relative suboptimal care for HIV-infected children. The unacceptably high HIV-related mortality in RLCs is also linked to the use of suboptimal antiretroviral regimens, nonadherence to ART, ART discontinuation as a result of drug toxicities, and the propensity for resistant viral strains [17].…”

Clinical associations of white matter damage in cART-treated HIV-positive children in South Africa

“…Children with the lowest neuropsychological functioning and cortical atrophy have been found to be at higher risk for disease progression (Pearson et al 2000). Factors which have been associated with mortality among HIV-infected children in rural Zambia include younger age, anemia, and lower weight for age (Sutcliffe et al 2011). Iron deficiency is a widespread problem in low socioeconomic countries.…”

Incidence and predictors of severe anemia in Asian HIV-infected children using first-line antiretroviral therapy

“…Anemia is commonly seen after ART initiation, whether due to pre-existing HIV-related bone marrow suppression or as a side effect of antiretrovirals like zidovudine (AZT) (1, 2). Anemia in HIV-infected patients has been associated with worse quality of life, disease progression and increased risk of death (1, 3–6). However, there is a lack of data on post-ART anemia in HIV-infected children in Asia (1).…”