Predictors of Mortality and Mortality Rate in a Cohort of Children Living with HIV from India
OBJECTIVES:
To
study the predictors of mortality and mortality rate in a clinical cohort of
Children Living with Human Immunodeficiency Virus infection (CLHIV) from India.
METHODS:
This
retrospective cohort analysis of CLHIV aged between 2 mo and 18 y
registered during January 2004 through December 2014 at Pediatric Centre of
Excellence (PCOE), Indira Gandhi Institute of Child Health (IGICH), was
conducted using standard data collection sheet. Demographic and clinical
characteristics of all eligible children were analyzed. The primary outcome
measured was mortality. The authors also analyzed the cause of death and
baseline parameters associated with death to study the predictors of mortality.
RESULTS:
Out of
1289 CLHIV registered in the PCOE during the study period, 834 (64.7 %)
CLHIV, with or without antiretroviral therapy (ART) care, were included. The
total time contributed by the study participants was 2872.8 child-years. The
mortality rate in these children was 4.9/100 child-years. A significantly
higher mortality rate of 28.2 % was found in children < 5 y,
38.6 % in children with advanced WHO clinical staging, 35.2 % among
severely immunosuppressed children and 22.3 % in severely malnourished
children. Tuberculosis accounted for 28 % of deaths. Univariate Cox
regression analysis showed treatment status, age <5 y, baseline WHO
clinical stage 3 and 4, severe immune suppression and severe malnutrition were
strongly associated with mortality.
CONCLUSIONS:
The
mortality rate in the index study cohort was 4.9/100 child-years and
tuberculosis was the major cause of death. Younger age, baseline advanced
clinical and immunological staging were predictors of mortality. Even though
mortality was significantly higher in Pre-ART children, treatment status was
not found to be an independent predictor of mortality.
- 1Department of Pediatrics, Indira Gandhi Institute of Child Health, South Hospital Complex, Dharmaram College Post, Bangalore, 560 029, Karnataka, India. sanju_gn@rediffmail.com.
- 2Pediatric Center of Excellence, Indira Gandhi Institute of Child Health, South Hospital Complex, Dharmaram College Post, Bangalore, 560 029, Karnataka, India. sanju_gn@rediffmail.com.
- 3Department of Pediatrics, Indira Gandhi Institute of Child Health, South Hospital Complex, Dharmaram College Post, Bangalore, 560 029, Karnataka, India.
- 4Pediatric Center of Excellence, Indira Gandhi Institute of Child Health, South Hospital Complex, Dharmaram College Post, Bangalore, 560 029, Karnataka, India.
- 5CST, Ministry of Health and Family Welfare, National AIDS Control Organization, Bangalore, Karnataka, India.
- 6DD (ICTC/PPTCT), KSAPS, Bangalore, Karnataka, India.
- Indian J Pediatr. 2016 Feb 26.
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