title: Outcomes of human immunodeficiency virus-infected children after anti-retroviral therapy in Malaysia.
abstract: OBJECTIVE
  To describe outcome and examine factors associated with mortality among human immunodeficiency virus (HIV)-infected children in Malaysia after anti-retroviral therapy (ART).
  
  
  METHODS
  Retrospective and prospective data collected through March 2009 from children in four different states in Malaysia enrolled in TREAT Asia's Pediatric HIV Observational Database were analysed.
  
  
  RESULTS
  Of 347 children in the cohort, only 278 (80.1%) were commenced on ART. The median CD4 count and median age at baseline prior to ART was 272 cells/μL and 4.2 years (interquartile range (IQR): 1.4, 7.4 years), respectively. The median duration of follow-up was 3.7 years (IQR: 1.8, 6.0) with 32 deaths giving a crude mortality rate of 2.86 per 100 child-years. The mortality rate highest in the first 6 months of ART was 10.62 per 100 child-years and declined to 1.83 per 100 child-years thereafter. On univariate analyses, only baseline median CD4 percentage, weight for age z score, height for age z score and anaemia were significantly associated with mortality. Upon including all four of these predictors into a single multivariate model, only weight for age z score remained statistically significantly predictive of mortality.
  
  
  CONCLUSIONS
  Children commenced on ART had high mortality in the first 6 months especially in those with low CD4 percentage, wasting and anaemia. Poor nutritional status is an important independent predictor of mortality in this study. Besides initiating ART therapy, nutritional support and intervention must receive the utmost attention.
authors.affiliation: Department of Paediatrics, Hospital Likas, Kota Kinabalu, Malaysia.
authors.forename: Fong Siew
authors.initials: FS
authors.lastname: Moy
authors.forename: Paul
authors.initials: P
authors.lastname: Fahey
authors.forename: Nik K
authors.initials: NK
authors.lastname: Nik Yusoff
authors.forename: Kamarul A
authors.initials: KA
authors.lastname: Razali
authors.forename: Revathy
authors.initials: R
authors.lastname: Nallusamy
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000740:Anemia / Q000139:chemically induced; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D001835:Body Weight / Q000187:drug effects; D018791:CD4 Lymphocyte Count; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy* / Q000401:mortality* / Q000503:physiopathology / Q000821:virology; D006801:Humans; D007223:Infant; D008296:Malaysia; D008297:Male; D009752:Nutritional Status / Q000187:drug effects; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D019380:Anti-HIV Agents
keywords: HIV; Malaysia; anti-retroviral; child; outcome