title: Mortality and associated factors after initiation of pediatric antiretroviral treatment in the Democratic Republic of the Congo.
abstract: 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.
authors.affiliation: School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC. callens@email.unc.edu
authors.forename: Steven F J
authors.initials: SF
authors.lastname: Callens
authors.forename: Nicole
authors.initials: N
authors.lastname: Shabani
authors.forename: Jean
authors.initials: J
authors.lastname: Lusiama
authors.forename: Patricia
authors.initials: P
authors.lastname: Lelo
authors.forename: Faustin
authors.initials: F
authors.lastname: Kitetele
authors.forename: Robert
authors.initials: R
authors.lastname: Colebunders
authors.forename: Ziya
authors.initials: Z
authors.lastname: Gizlice
authors.forename: Andrew
authors.initials: A
authors.lastname: Edmonds
authors.forename: Annelies
authors.initials: A
authors.lastname: Van Rie
authors.forename: Frieda
authors.initials: F
authors.lastname: Behets
mesh_terms: 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
chemical_list: D044966:Anti-Retroviral Agents