Mortality and associated factors after initiation of pediatric antiretroviral treatment in the Democratic Republic of the Congo.
OBJECTIVE
We aimed to describe factors associated with mortality among children receiving antiretroviral treatment (ART) at a pediatric hospital in Kinshasa, Democratic Republic of the Congo.


RESULTS
Two hundred ninety-nine children, <18 years old, were followed for a median of 77 weeks (interquartile range: 61-103) post-ART initiation. Survival probability was 89.6% [95% confidence interval (CI): 85.5-92.6%] at 12 months; 24 of 31 deaths (77.4%) occurred within 2 months of ART initiation. Predictors of mortality in bivariate analysis were >/=2 opportunistic infections before ART initiation, severe immunosuppression as defined by age-specific CD4 count or percentage criteria, hemoglobin <9 g/dL, oral candidiasis, and severe malnutrition. In multivariate analysis, weight for age z-score [hazard ratio (HR): 0.39; 95% CI: 0.27-0.61; P < 0.001] and oral candidiasis (HR: 5.86; 95% CI: 2.34-14.65; P = 0.0002) were independent predictors of mortality. Suspected septic shock was the most common cause of death (n = 12/31, 38.7%).


CONCLUSIONS
Children receiving ART in this resource-poor setting were at the highest risk of dying in the first 2 months of ART, particularly when they presented with malnutrition or oral candidiasis. Optimal timing of ART initiation during nutritional rehabilitation should be determined. Promotion of early care seeking, strengthened health care, and prevention services are important to further improve outcome of pediatric ART in resource-poor settings.
Callens
Steven F J
SF
School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC. callens@email.unc.edu
Shabani
Nicole
N
Lusiama
Jean
J
Lelo
Patricia
P
Kitetele
Faustin
F
Colebunders
Robert
R
Gizlice
Ziya
Z
Edmonds
Andrew
A
Van Rie
Annelies
A
Behets
Frieda
F
D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology / Q000821:virology; D000293:Adolescent; D000704:Analysis of Variance; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D002180:Candidiasis, Oral / Q000453:epidemiology / Q000821:virology; D002648:Child; D015362:Child Nutrition Disorders / Q000453:epidemiology / Q000821:virology; D002675:Child, Preschool; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality* / Q000821:virology; D006801:Humans; D008297:Male; D011379:Prognosis; D016016:Proportional Hazards Models; D012772:Shock, Septic / Q000453:epidemiology / Q000821:virology
D044966:Anti-Retroviral Agents