title: Predicting mortality in HIV-infected children initiating highly active antiretroviral therapy in a resource-deprived setting.
abstract: BACKGROUND
  While highly active antiretroviral therapy (HAART) programs have been scaled up across sub-Saharan Africa, no prognostic models for the prediction of mortality risk for children initiating HAART are widely available. Current clinical prediction tools for human immunodeficiency virus (HIV)-infected children are derived from pre-HAART data and therefore cannot predict mortality for children initiating HAART. The purpose of this study was to develop a mortality risk scoring system for HIV-infected children beginning HAART in a resource-deprived setting.
  
  
  METHODS
  Observational data from HIV-infected children initiating HAART from December 2004 through March 2012 in Kinshasa, Democratic Republic of Congo, were analyzed. Cox proportional hazards models were constructed to assess associations between demographic and clinical characteristics at the time of HAART initiation and mortality. Each child received a model-based risk score predicting mortality after HAART initiation.
  
  
  RESULTS
  By 31 March 2012, 1010 children had started HAART. One hundred three children (10.2%) died at a median of 5.3 months post-HAART initiation, yielding a mortality rate of 3.4 deaths per 100 child-years. The final mortality prediction model included undernutrition, low CD4 count, HIV symptoms, and low total lymphocyte count. These factors were highly predictive of mortality in the study population (C statistic = 0.79) and performed well when applied to the validation population (C statistic = 0.77).
  
  
  CONCLUSIONS
  Mortality among children starting HAART in resource-deprived settings can be predicted using a simple scoring system incorporating several readily available factors. Identifying predictors of mortality will help clinicians target modifiable risk factors, such as undernutrition, which are not directly addressed by HAART.
authors.affiliation: From *Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD; †Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC; ‡The University of Kinshasa, School of Public Health, Kinshasa, Democratic Republic of Congo; §Department of Epidemiology and School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC.
authors.forename: James
authors.initials: J
authors.lastname: Nugent
authors.forename: Andrew
authors.initials: A
authors.lastname: Edmonds
authors.forename: Jean
authors.initials: J
authors.lastname: Lusiama
authors.forename: Deidre
authors.initials: D
authors.lastname: Thompson
authors.forename: Frieda
authors.initials: F
authors.lastname: Behets
mesh_terms: D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D002648:Child; D015362:Child Nutrition Disorders / Q000453:epidemiology; D002675:Child, Preschool; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D003906:Developing Countries; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality*; D006801:Humans; D007223:Infant; D008297:Male; D015233:Models, Statistical; D016016:Proportional Hazards Models; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors