Predictors of Mortality in a Clinic Cohort of HIV-1 Infected Children Initiated on Antiretroviral Therapy in Jos, Nigeria

Details

• Alternative Title:
  J AIDS Clin Res
• Personal Author:
  Ebonyi, Augustine O ; Oguche, Stephen ; Meloni, Seema T ; Sagay, Solomon A ; Kyriacou, Demetrios N ; Achenbach, Chad J ; Agbaji, Oche O ; Oyebode, Tinuade A ; Okonkwo, Prosper ; Idoko, John A ; Kanki, Phyllis J
• Description:
  Background:
  
  Mortality among human immunodeficiency virus-1 (HIV-1) infected children initiated on antiretroviral therapy (ART) though on a decline still remains high in resource-limited countries (RLC). Identifying baseline factors that predict mortality could allow their possible modification in order to improve pediatric HIV care and reduce mortality.
  
  Methods:
  
  We conducted a retrospective cohort study analyzing data on 691 children, aged 2 months-15 years, diagnosed with HIV-1 infection and initiated on ART between July 2005 and March 2013 at the pediatric HIV clinic of Jos University Teaching Hospital. Lost to follow-up children were excluded from the analyses. A multivariate Cox proportional hazards model was fitted to identify predictors of mortality.
  
  Results:
  
  Median follow-up time for the 691 children initiated on ART was 4.4 years (interquartile range (IQR), 1.8-5.9) and at the end of 2752 person-years of follow-up, 32 (4.6%) had died and 659 (95.4%) survived. The mortality rate was 1.0 per 100 child-years of follow-up period. The median age of those who died was about two times lower than that of survivors [1.7 years (IQR, 0.6-3.6) versus 3.9 years (IQR, 3.9-10.3), p<0.001]. On unadjusted Cox regression, the risk of dying was about three and half times more in children <5 years of age compared to those >5 years (p=0.02) Multivariate modeling identified age as the main predictor of death with mortality decreasing by 24% for every 1 year increase in age (Adjusted Hazard Ratio (AHR)=0.76 [0.62-0.94], p=0.013.
  
  Conclusion:
  
  The lower mortality rate for our study suggests that even in RLC, mortality rates could be reduced given a good standard of care. Early initiation of ART in younger children with close monitoring during follow-up could further reduce mortality.
  
  
• Keywords:
  ART Children HIV-1 Mortality Severe Immunodeficiency
• Source:
  J AIDS Clin Res. 5(12)
• Pubmed ID:
  30416842
• Pubmed Central ID:
  PMC6223308
• Document Type:
  Journal Article
• Funding:
  D43 TW010130/TW/FIC NIH HHSUnited States/ ; R24 TW008878/TW/FIC NIH HHSUnited States/ ; U2G PS001058/PS/NCHHSTP CDC HHSUnited States/
• Place as Subject:
  Nigeria
• Volume:
  5
• Issue:
  12
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:8f75e41421452a4df5ab7999e585ddd7999c300c9830ca8b0534ef668495def1
• Download URL:
  https://stacks.cdc.gov/view/cdc/60714/cdc_60714_DS1.pdf
• File Type:
  [PDF - 207.57 KB ]