Severe morbidity and mortality in untreated HIV-infected children in a paediatric care programme in Abidjan, Côte d'Ivoire, 2004-2009

Abstract

BackgroundClinical evolution of HIV-infected children who have not yet initiated antiretroviral treatment (ART) is poorly understood in Africa. We describe severe morbidity and mortality of untreated HIV-infected children.MethodsAll HIV-infected children enrolled from 2004-2009 in a prospective HIV programme in two health facilities in Abidjan, Côte d'Ivoire, were eligible from their time of inclusion. Risks of severe morbidity (the first clinical event leading to death or hospitalisation) and mortality were documented retrospectively and estimated using cumulative incidence functions. Associations with baseline characteristics were assessed by competing risk regression models between outcomes and antiretroviral initiation.Results405 children were included at a median age of 4.5 years; at baseline, 66.9% were receiving cotrimoxazole prophylaxis, and 27.7% met the 2006 WHO criteria for immunodeficiency by age. The risk of developing a severe morbid event was 14% (95%CI: 10.7 - 17.8) at 18 months; this risk was lower in children previously exposed to any prevention of mother-to-child-transmission (PMTCT) intervention (adjusted subdistribution hazard ratio [sHR]: 0.16, 95% CI: 0.04 - 0.71) versus those without known exposure. Cumulative mortality reached 5.5% (95%CI: 3.5 - 8.1) at 18 months. Mortality was associated with immunodeficiency (sHR: 6.02, 95% CI: 1.28-28.42).ConclusionsHaving benefited from early access to care minimizes the severe morbidity risk for children who acquire HIV. Despite the receipt of cotrimoxazole prophylaxis, the risk of severe morbidity and mortality remains high in untreated HIV-infected children. Such evidence adds arguments to promote earlier access to ART in HIV-infected children in Africa and improve care interventions in a context where treatment is still not available to all.

Pediatric HIV/AIDS in sub-Saharan Africa: emerging issues and way forward

“…While, there have been success stories coming out of Africa with respect to the PMTCT programs, the vast majority of the affected do not have access to these programs 7 . Studies have also demonstrated the benefits of early care and antiretroviral therapy in reducing morbidity and mortality in HIV infected children 13,14,15 . This informed the World Health Organization (WHO) policy statement that all HIV infected children less than 24 months be commenced on highly active anti-retroviral therapy (HAART) as soon as HIV diagnosis is made.…”

Association between age at antiretroviral therapy initiation and 24-month immune response in West-African HIV-infected children

“…When untreated, HIV-infected children experience increased risks of severe morbidity and mortality, through immunodeficiency [2–5]. Antiretroviral therapy (ART) is the standard treatment of HIV [6].…”

Obstetrical, maternal characteristics and outcome of HIV-infected rapid progressor infants at Yaounde: a retrospective study

“…It others setting very high mortality rate where found in infants who were not on ARV compared to those receiving ARV treatment (14). Death occurred in our study at a median age of 7 months; HIV infection increased the death rate before the age of 2 years considerably (39,40).…”

“…Before that Blanche et al showed that 44% of HIV-1 infected infants born to mothers with severe disease at delivery, will die during the first 18 months of life as a result of HIV encephalopathy and opportunistic infections (12). Rapid progressors are infants who develop severe signs of AIDS very early in life usually leading to death for most of them (13,14). Many factors are described in literature concerning HIV-infected rapid progressors (15)(16)(17)(18).…”