Risk Factors for Mortality in HIV Infected Children Starting ART in South Africa
Author Information
Author(s): Zanoni Brian C., Phungula Thuli, Zanoni Holly M., France Holly, Feeney Margaret E.
Primary Institution: The Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology, and Harvard
Hypothesis
What demographic and clinical risk factors are associated with mortality after initiation of antiretroviral therapy in HIV infected children?
Conclusion
Young age, low CD4 percentage, chronic diarrhea, and low weight-for-age Z-score are significant risk factors for mortality in HIV-infected children starting ART, with female gender also being a notable risk factor.
Supporting Evidence
- 47 deaths occurred in the cohort of 537 children initiating ART.
- Mortality rate was 4.7 deaths per 100 child years on ART.
- Significant associations with mortality included lower weight-for-age Z-score, chronic diarrhea, lower hemoglobin, age <3 years, and CD4% <10%.
- Female gender was significantly associated with mortality when controlling for other risk factors.
Takeaway
This study found that young children and those with low immune function or chronic diarrhea are more likely to die after starting HIV treatment, and girls may be at higher risk too.
Methodology
A retrospective cohort study analyzing medical records of 537 children who initiated ART, assessing risk factors using Cox regression analysis.
Potential Biases
Potential selection bias due to the study being conducted in a semi-private institution with nominal fees.
Limitations
The study is based on a single cohort from a semi-private hospital, which may not be generalizable to poorer populations.
Participant Demographics
Children aged ≤18 years, mostly Zulu speaking population in Durban, South Africa.
Statistical Information
P-Value
p<0.0001 for weight-for-age Z-score, p=0.0002 for chronic diarrhea, p=0.002 for hemoglobin, p=0.003 for age <3 years, p=0.005 for CD4% <10%.
Confidence Interval
Not specified.
Statistical Significance
p<0.05
Digital Object Identifier (DOI)
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