Predictors of mortality among HIV-infected children receiving highly active antiretroviral therapy.
OBJECTIVE
The mortality rate of HIV-infected children can be reversed under highly active antiretroviral therapy (HAART). The impact of HAART on the mortality of HIV-infected children in Cameroon has not been extensively documented. We aimed to measure the mortality rate of HIV-infected children under HAART and to identify predictive factors of mortality.


METHODS
Retrospective cohort study of 221 children initiated on HAART from 2005 to 2009 and followed-up until 2013. Survival data was analyzed using Kaplan Meier method and Cox regression model to identify independent predictors of child mortality on HAART.


RESULTS
Overall, 9.9% of children (n=22) died over a follow-up period of 755 child-years (mortality of 2.9 per 100 child-years); 70% of deaths occurred during the first six months of HAART. The probability of survival after four years of treatment was 88.7% (95% CI=[84.2-93.3]). During the multivariate analysis of baseline variables, we observed that the WHO clinical stages III and IV (HR: 3.55 [1.09-13.6] and HR: 7.7 [3.07-31.2]) and age≤1year at HAART initiation were independently associated with death (HR: 2.1 [1.01-5.08]). Neither orphanhood, baseline CD4 count or hemoglobin level nor low nutritional status predicted death in this cohort.


CONCLUSIONS
The mortality of children receiving HAART was low after five years of follow-up and it was strongly associated with WHO stages III and IV and a younger age at treatment initiation.
Department of pediatrics, National Social Insurance Fund Hospital, centre hospitalier d'ESSOS, PO Box 5777, Yaoundé, Cameroon. Electronic address: anne.njom@gmail.com.
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Njom Nlend
École polytechnique Yaoundé, Specialized Masters in Mathematics, Yaoundé, Cameroon. Electronic address: branly.loussikila@gmail.com.
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Loussikila
D000293:Adolescent; D023241:Antiretroviral Therapy, Highly Active; D002163:Cameroon; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality*; D006801:Humans; D007223:Infant; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate
Cameroon; Cameroun; Children; Enfants; HAART; HIV; Traitement antirétroviral hautement actif; VIH