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. 2012 Sep;130(3):e591-9.
doi: 10.1542/peds.2011-1187. Epub 2012 Aug 13.

Mortality and clinical outcomes in HIV-infected children on antiretroviral therapy in Malawi, Lesotho, and Swaziland

Mark M Kabue  1 , W Chris Buck, Sebastian R Wanless, Carrie M Cox, Eric D McCollum, A Chantal Caviness, Saeed Ahmed, Maria H Kim, Lineo Thahane, Andrew Devlin, Duncan Kochelani, Peter N Kazembe, Nancy R Calles, Michael B Mizwa, Gordon E Schutze, Mark W Kline
Affiliations

Mortality and clinical outcomes in HIV-infected children on antiretroviral therapy in Malawi, Lesotho, and Swaziland

Mark M Kabue et al. Pediatrics. 2012 Sep.

Abstract

Objective: To determine mortality and immune status improvement in HIV-infected pediatric patients on antiretroviral treatment (ART) in Malawi, Lesotho, and Swaziland.

Methods: We conducted a retrospective cohort study of patients aged <12 years at ART initiation at 3 sites in sub-Saharan Africa between 2004 and 2009. Twelve-month and overall mortality were estimated, and factors associated with mortality and immune status improvement were evaluated.

Results: Included in the study were 2306 patients with an average follow-up time on ART of 2.3 years (interquartile range 1.5-3.1 years). One hundred four patients (4.5%) died, 9.0% were lost to follow-up, and 1.3% discontinued ART. Of the 104 deaths, 77.9% occurred in the first year of treatment with a 12-month mortality rate of 3.5%. The overall mortality rate was 2.25 deaths/100 person-years (95% confidence interval [CI] 1.84-2.71). Increased 12-month mortality was associated with younger age; <6 months (hazard ratio [HR] = 8.11, CI 4.51-14.58), 6 to <12 months (HR = 3.43, CI 1.96-6.02), and 12 to <36 months (HR = 1.92, CI 1.16-3.19), and World Health Organization stage IV (HR = 4.35, CI 2.19-8.67). Immune status improvement at 12 months was less likely in patients with advanced disease and age <12 months.

Conclusions: Despite challenges associated with pediatric ART in developing countries, low mortality and good treatment outcomes can be achieved. However, outcomes are worse in younger patients and those with advanced disease at the time of ART initiation, highlighting the importance of early diagnosis and treatment.

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Figures

FIGURE 1
FIGURE 1
Kaplan-Meier mortality curve for all study participants.
FIGURE 2
FIGURE 2
Kaplan-Meier mortality curve for age at initiation of ART. Log-rank test (for equality of survival distributions over different age categorizations): P < .0001. HAART, highly active ART.
FIGURE 3
FIGURE 3
Kaplan-Meier curve for baseline WHO clinical staging and mortality adjusting for age at ART initiation. Log-rank test (for equality of survival distributions over different WHO stages): P < .0001.
See this image and copyright information in PMC

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