Mortality and clinical outcomes in HIV-infected children on antiretroviral therapy in Malawi, Lesotho, and Swaziland.
OBJECTIVE
To determine mortality and immune status improvement in HIV-infected pediatric patients on antiretroviral treatment (ART) in Malawi, Lesotho, and Swaziland.


METHODS
We conducted a retrospective cohort study of patients aged <12 years at ART initiation at 3 sites in sub-Saharan Africa between 2004 and 2009. Twelve-month and overall mortality were estimated, and factors associated with mortality and immune status improvement were evaluated.


RESULTS
Included in the study were 2306 patients with an average follow-up time on ART of 2.3 years (interquartile range 1.5-3.1 years). One hundred four patients (4.5%) died, 9.0% were lost to follow-up, and 1.3% discontinued ART. Of the 104 deaths, 77.9% occurred in the first year of treatment with a 12-month mortality rate of 3.5%. The overall mortality rate was 2.25 deaths/100 person-years (95% confidence interval [CI] 1.84-2.71). Increased 12-month mortality was associated with younger age; <6 months (hazard ratio [HR] = 8.11, CI 4.51-14.58), 6 to <12 months (HR = 3.43, CI 1.96-6.02), and 12 to <36 months (HR = 1.92, CI 1.16-3.19), and World Health Organization stage IV (HR = 4.35, CI 2.19-8.67). Immune status improvement at 12 months was less likely in patients with advanced disease and age <12 months.


CONCLUSIONS
Despite challenges associated with pediatric ART in developing countries, low mortality and good treatment outcomes can be achieved. However, outcomes are worse in younger patients and those with advanced disease at the time of ART initiation, highlighting the importance of early diagnosis and treatment.
Baylor College of Medicine Abbott Fund Children's Clinical Centre of Excellence-Malawi, Private Bag B397, Lilongwe 03, Malawi. mmkabue@gmail.com
Mark M
MM
Kabue
W Chris
WC
Buck
Sebastian R
SR
Wanless
Carrie M
CM
Cox
Eric D
ED
McCollum
A Chantal
AC
Caviness
Saeed
S
Ahmed
Maria H
MH
Kim
Lineo
L
Thahane
Andrew
A
Devlin
Duncan
D
Kochelani
Peter N
PN
Kazembe
Nancy R
NR
Calles
Michael B
MB
Mizwa
Gordon E
GE
Schutze
Mark W
MW
Kline
D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D002648:Child; D002675:Child, Preschool; D013541:Eswatini / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality*; D006801:Humans; D007223:Infant; D007927:Lesotho / Q000453:epidemiology; D008295:Malawi / Q000453:epidemiology; D008297:Male; D009752:Nutritional Status
D044966:Anti-Retroviral Agents