The impact of malnutrition in survival of HIV infected children after initiation of antiretroviral treatment (ART)

Abstract

Background: Malnutrition is a common condition in HIV-infected children; however, its impact in survival of HIV infected children after initiation ofantiretroviral therapy is not well understood.

Objective: To assess the impact of malnutrition in survival of HIV infected children after initiation of antiretroviral treatment.

Methods: A retrospective cohort study was conducted in HIV infected children starting antiretroviral treatment at Zewditu memorial hospital, Addis Ababa, Ethiopia. Demographic, nutritional, clinical and immunological data were carefully extracted from the existing ART logbook and patient follow up cards. Accordingly, nutritional status were defined with stunting (height for age Z score < -2), Wasting (weight for height Z score -2) and under weight (weight for age Z score < -2). Survival was defined as the tidne from nutritional and immunologic evaluation to death. Data were analyzed for univariate and multivariate analysis using Cox regression proportional hazard model. Survival rate was calculated and compare with the Kaplan Meier and log rank tests.

Results: A total of 475 HIV infected children starting antiretroviral treatment (ART) from March 21 2005 to 30 April 2008 were included in the study. Of whom 42 (8.8%) died during a median study follow up of 12 months. The average survival time for the entire cohort was 27.9 months. Independent baseline predictors of mortality were severe wasting (Hazard ratio (HR) = 4.99, 95% CI 2.4-10.2, P < 0.00), absolute CD4 below the threshold for severe immunodeficiency (HR = 3.02, 95% CI 1.02-8.96, P = 0.04) and low hemoglobin value (HR = 2.92, 95% CI 1.3-6.7, P = 0.001 for those hemoglobin value < 7.0 gm/dl). The probability of surviving for wasted children declines sharply starting from 6th months and reach 76% in 12th months.

Conclusion: Despite the apparent benefit of ART use HIV related survival, severe wasting (WHZ < -3) appear to be strong independent predictor of survival in HIV infected children receiving ART.