title: Mortality of HIV-infected and uninfected children in a longitudinal cohort in rural south-west Uganda during 8 years of follow-up.
abstract: OBJECTIVE
  To determine the impact of HIV on child mortality and explore potential risk factors for mortality among HIV-infected and HIV-exposed uninfected children in a longitudinal cohort in rural Uganda.
  
  
  METHODS
  From July 2002 to March 2010, HIV-infected and HIV-exposed uninfected children aged 6 weeks-13 years were enrolled in an open population-based clinical cohort. Antiretroviral therapy (ART) was introduced in 2005. Clinical and laboratory data were collected every 3 months. Person-years at risk were calculated from time of enrolment until earliest date of ART initiation, death or last visit. Cox regression was used to estimate hazard ratios (HR) for mortality.
  
  
  RESULTS
  Eighty-nine (30.2%) HIV-infected and 206 (69.8%) HIV-exposed but uninfected children were enrolled. Twenty-one children died. The mortality rate was six times higher in ART-naive HIV-infected children than in HIV-exposed but uninfected children (HR = 6.4, 95% CI = 2.4-16.6). Among HIV-infected children, mortality was highest in those aged <2 years. Decreasing weight-for-age Z (WAZ) score was the strongest risk factor for mortality among HIV-infected children (HR for unit decrease in WAZ = 2.6, 95% CI = 1.6-4.1). Thirty-five children (aged 7 months-15.6 years; median, 5.4 years) started ART.
  
  
  CONCLUSIONS
  Mortality among HIV-infected children was highest among those aged <2 years. Intensified efforts to prevent mother-to-child transmission of HIV and ensure early HIV diagnosis and treatment are required to decrease child mortality caused by HIV in rural Africa.
authors.affiliation: MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda. mmunyagwa@yahoo.co.uk
authors.forename: Mary
authors.initials: M
authors.lastname: Munyagwa
authors.forename: Kathy
authors.initials: K
authors.lastname: Baisley
authors.forename: Jonathan
authors.initials: J
authors.lastname: Levin
authors.forename: Michael
authors.initials: M
authors.lastname: Brian
authors.forename: Heiner
authors.initials: H
authors.lastname: Grosskurth
authors.forename: Dermot
authors.initials: D
authors.lastname: Maher
mesh_terms: D000293:Adolescent; D019380:Anti-HIV Agents / Q000627:therapeutic use; D002648:Child; D046688:Child Mortality / Q000639:trends*; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006678:HIV / Q000302:isolation & purification*; D015658:HIV Infections / Q000188:drug therapy / Q000401:mortality* / Q000635:transmission; D006801:Humans; D007223:Infant; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008137:Longitudinal Studies; D008297:Male; D015999:Multivariate Analysis; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data*; D014454:Uganda / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents