Growth, morbidity, and mortality in a cohort of institutionalized HIV-1-infected African children.
OBJECTIVE
As a result of the HIV epidemic in Africa, much debate exists on whether institutionalized compared with community-based care provides optimum management of infected children. Previous reports calculated 89% mortality by age 3 years among outpatients in Malawi. No similar data are available for infected children in institutionalized care. We characterized patterns of morbidity and mortality among HIV-1-infected children residing at an orphanage in Nairobi.


METHODS
Medical records for 174 children followed over 5 years were reviewed. Mortality was analyzed by Kaplan-Meier methods with adjustment to account for survival in the community before admission. Anthropometric indices were calculated to include mean z scores for weight for length and length for age. Low indices reflected wasting and stunting. Opportunistic infections were documented.


RESULTS
Of 174 children, 64 had died. Survival was 70% at age 3 years. Morbidity included recurrent respiratory tract infections, gastroenteritis, parotitis, and lymphoid interstitial pneumonitis. No new cases of tuberculosis disease were noted after admission. Mean z scores for length for age suggested overall stunting (z = -1.65). Wasting was not observed (z = -0.39).


CONCLUSIONS
The optimal form of care for HIV-infected children in resource-poor settings may be the development of similar homes. Absence of tuberculosis disease in long-standing residents may have contributed to improved survival. Stunting in the absence of wasting implied that growth was compromised by opportunistic infections and other cofactors.
Nathan
Lisa M
LM
School of Medicine, Rush University, Chicago, Illinois, USA.
Nerlander
Lina M
LM
Dixon
Jedediah R
JR
Ripley
Ruth M
RM
Barnabas
Ruanne
R
Wholeben
Brent E
BE
Musoke
Rachel
R
Palakudy
Tresa
T
D'Agostino
Angelo
A
Chakraborty
Rana
R
D000163:Acquired Immunodeficiency Syndrome / Q000401:mortality* / Q000503:physiopathology; D000293:Adolescent; D002648:Child; D002674:Child, Institutionalized; D002675:Child, Preschool; D015331:Cohort Studies; D006128:Growth; D015497:HIV-1; D006801:Humans; D007223:Infant; D007630:Kenya / Q000453:epidemiology; D009017:Morbidity; D012189:Retrospective Studies