Risk factors for early mortality in children on adult fixed-dose combination antiretroviral treatment in a central hospital in Malawi.
OBJECTIVE
In children aged less than 15 years, to determine the cumulative proportion of deaths occurring within 3 and 6 months of starting split-tablet adult fixed-dose combination antiretroviral therapy (ART) and to identify risk factors associated with early deaths.


METHODS
A retrospective cohort analysis.


METHODS
Data were collected and analysed from ART patient master cards and the ART register of all children registered for treatment between July 2004 and September 2006 in the ART clinic at Mzuzu Central Hospital, northern Malawi.


RESULTS
A total of 439 children started on ART, of whom 220 (50%) were male; 37 (8%) were aged less than 18 months, 172 (39%) 18 months to 5 years, and 230 (52%) were 6-14 years. By September 2006, 49 children (11%) had died, of whom 35 (71%) died by 3 months and 44 (89%) by 6 months. The cumulative incidence of death at 3, 6, 12 and 24 months after ART was 8, 12, 13 and 15%, respectively. After multivariate analysis, being in World Health Organization clinical stage 4, having severe wasting and severe immunodeficiency were factors significantly associated with 3-month mortality and 6-month mortality, respectively.


CONCLUSIONS
Although children do well on ART, there is high early mortality. Scaling up HIV testing and simple diagnostic tests for infants and children, expanding routine provision of cotrimoxazole prophylaxis, and investigating the role of nutritional interventions are three measures that, if implemented and expanded countrywide, may improve ART outcomes.
Bong
Chin-Nam
CN
Taiwan Medical Mission, International Cooperation and Development Fund, Mzuzu Central Hospital, Mzuzu, Malawi.
Yu
Joseph Kwong-Leung
JK
Chiang
Hung-Che
HC
Huang
Wen-Ling
WL
Hsieh
Tsung-Che
TC
Schouten
Erik J
EJ
Makombe
Simon D
SD
Kamoto
Kelita
K
Harries
Anthony D
AD
D000293:Adolescent; D000886:Anthropometry; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D015992:Body Mass Index; D018791:CD4 Lymphocyte Count; D002648:Child; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome
D019380:Anti-HIV Agents