title: Pneumonia and malnutrition are highly predictive of mortality among African children hospitalized with human immunodeficiency virus infection or exposure in the era of antiretroviral therapy.
abstract: OBJECTIVE
  To identify clinical characteristics predicting death among inpatients who are infected with or exposed to human immunodeficiency virus (HIV) during a period of pediatric antiretroviral therapy scale-up in sub-Saharan Africa.
  
  
  METHODS
  Retrospective review of medical records from every child with HIV infection (n = 834) or exposure (n = 351) identified by routine inpatient testing in Kamuzu Central Hospital, Lilongwe, Malawi, September 2007 through December 2008.
  
  
  RESULTS
  The inpatient mortality rate was high among children with HIV infection (16.6%) and exposure (13.4%). Clinically diagnosed Pneumocystis pneumonia or very severe pneumonia independently predicted death in inpatients with HIV infection (OR 14; 95% CI 8.2 to 23) or exposure (OR 21; CI 8.4 to 50). Severe acute malnutrition independently predicted death in children who are HIV infected (OR 2.2; CI 1.7 to 3.9) or exposed (OR 5.1; CI 2.3 to 11). Other independent predictors of death were septicemia, Kaposi sarcoma, meningitis, and esophageal candidiasis for children infected with HIV, and meningitis and severe anemia for inpatients exposed to HIV.
  
  
  CONCLUSIONS
  Severe respiratory tract infections and malnutrition are both highly prevalent and strongly associated with death among hospitalized children who are HIV infected or exposed. Novel programmatic and therapeutic strategies are urgently needed to reduce the high mortality rate among inpatients with HIV infection and HIV exposure in African pediatric hospitals.
authors.affiliation: Interdepartmental Program in Translational Biology and Molecular Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA. preidis@post.harvard.edu
authors.forename: Geoffrey A
authors.initials: GA
authors.lastname: Preidis
authors.forename: Eric D
authors.initials: ED
authors.lastname: McCollum
authors.forename: Charles
authors.initials: C
authors.lastname: Mwansambo
authors.forename: Peter N
authors.initials: PN
authors.lastname: Kazembe
authors.forename: Gordon E
authors.initials: GE
authors.lastname: Schutze
authors.forename: Mark W
authors.initials: MW
authors.lastname: Kline
mesh_terms: D000740:Anemia / Q000401:mortality; D002177:Candidiasis / Q000401:mortality; D002675:Child, Preschool; D015331:Cohort Studies; D004935:Esophageal Diseases / Q000401:mortality; D005260:Female; D015658:HIV Infections / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D008295:Malawi / Q000453:epidemiology; D008297:Male; D044342:Malnutrition / Q000401:mortality*; D008581:Meningitis / Q000401:mortality; D011014:Pneumonia / Q000401:mortality*; D012189:Retrospective Studies; D012514:Sarcoma, Kaposi / Q000401:mortality; D018805:Sepsis / Q000401:mortality; D012720:Severity of Illness Index