Predictors of mortality in HIV-1 infected children on antiretroviral therapy in Kenya: a prospective cohort
<p>Abstract</p> <p>Background</p> <p>Among children, early mortality following highly active antiretroviral therapy (HAART) remains high. It is important to define correlates of mortality in order to improve outcome.</p> <p>Methods</p> <p>HIV-1-i...
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| Format: | Article |
| Language: | English |
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BMC
2010-05-01
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| Series: | BMC Pediatrics |
| Online Access: | http://www.biomedcentral.com/1471-2431/10/33 |
| _version_ | 1811283611235647488 |
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| author | Mbori-Ngacha Dorothy A Richardson Barbra A Farquhar Carey Obimbo Elizabeth M Wamalwa Dalton C Inwani Irene Benki-Nugent Sara John-Stewart Grace |
| author_facet | Mbori-Ngacha Dorothy A Richardson Barbra A Farquhar Carey Obimbo Elizabeth M Wamalwa Dalton C Inwani Irene Benki-Nugent Sara John-Stewart Grace |
| author_sort | Mbori-Ngacha Dorothy A |
| collection | DOAJ |
| description | <p>Abstract</p> <p>Background</p> <p>Among children, early mortality following highly active antiretroviral therapy (HAART) remains high. It is important to define correlates of mortality in order to improve outcome.</p> <p>Methods</p> <p>HIV-1-infected children aged 18 months-12 years were followed up at Kenyatta National Hospital, Nairobi after initiating NNRTI-based HAART. Cofactors for mortality were determined using multivariate Cox regression models.</p> <p>Results</p> <p>Between August 2004 and November 2008, 149 children were initiated on HAART of whom 135 were followed for a total of 238 child-years (median 21 months) after HAART initiation. Baseline median CD4% was 6.8% and median HIV-1-RNA was 5.98-log<sub>10 </sub>copies/ml. Twenty children (13.4%) died at a median of 35 days post-HAART initiation. Mortality during the entire follow-up period was 8.4 deaths per 100 child-years (46 deaths/100 child-years in first 4 months and 1.0 deaths/100 child-years after 4 months post-HAART initiation). On univariate Cox regression, baseline hemoglobin (Hb) <9 g/dl, weight-for-height z-score (WHZ) < -2, and WHO clinical stage 4 were associated with increased risk of death (Hb <9 g/dl HR 3.00 [95% C.I. 1.21-7.39], p = 0.02, WHZ < -2 HR 3.41 [95% C.I. 1.28-9.08], p = 0.01, and WHO clinical stage 4, HR 3.08 [1.17-8.12], p = 0.02). On multivariate analysis Hb < 9 g/dl remained predictive of mortality after controlling for age, baseline CD4%, WHO clinical stage and weight-for-height z-score (HR 2.95 (95% C.I. 1.04-8.35) p = 0.04).</p> <p>Conclusion</p> <p>High early mortality was observed in this cohort of Kenyan children receiving HAART, and low baseline hemoglobin was an independent risk factor for death.</p> |
| first_indexed | 2024-04-13T02:15:42Z |
| format | Article |
| id | doaj.art-3da6c26864a74ff7b2e045dbbe0d2dfb |
| institution | Directory Open Access Journal |
| issn | 1471-2431 |
| language | English |
| last_indexed | 2024-04-13T02:15:42Z |
| publishDate | 2010-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pediatrics |
| spelling | doaj.art-3da6c26864a74ff7b2e045dbbe0d2dfb2022-12-22T03:07:10ZengBMCBMC Pediatrics1471-24312010-05-011013310.1186/1471-2431-10-33Predictors of mortality in HIV-1 infected children on antiretroviral therapy in Kenya: a prospective cohortMbori-Ngacha Dorothy ARichardson Barbra AFarquhar CareyObimbo Elizabeth MWamalwa Dalton CInwani IreneBenki-Nugent SaraJohn-Stewart Grace<p>Abstract</p> <p>Background</p> <p>Among children, early mortality following highly active antiretroviral therapy (HAART) remains high. It is important to define correlates of mortality in order to improve outcome.</p> <p>Methods</p> <p>HIV-1-infected children aged 18 months-12 years were followed up at Kenyatta National Hospital, Nairobi after initiating NNRTI-based HAART. Cofactors for mortality were determined using multivariate Cox regression models.</p> <p>Results</p> <p>Between August 2004 and November 2008, 149 children were initiated on HAART of whom 135 were followed for a total of 238 child-years (median 21 months) after HAART initiation. Baseline median CD4% was 6.8% and median HIV-1-RNA was 5.98-log<sub>10 </sub>copies/ml. Twenty children (13.4%) died at a median of 35 days post-HAART initiation. Mortality during the entire follow-up period was 8.4 deaths per 100 child-years (46 deaths/100 child-years in first 4 months and 1.0 deaths/100 child-years after 4 months post-HAART initiation). On univariate Cox regression, baseline hemoglobin (Hb) <9 g/dl, weight-for-height z-score (WHZ) < -2, and WHO clinical stage 4 were associated with increased risk of death (Hb <9 g/dl HR 3.00 [95% C.I. 1.21-7.39], p = 0.02, WHZ < -2 HR 3.41 [95% C.I. 1.28-9.08], p = 0.01, and WHO clinical stage 4, HR 3.08 [1.17-8.12], p = 0.02). On multivariate analysis Hb < 9 g/dl remained predictive of mortality after controlling for age, baseline CD4%, WHO clinical stage and weight-for-height z-score (HR 2.95 (95% C.I. 1.04-8.35) p = 0.04).</p> <p>Conclusion</p> <p>High early mortality was observed in this cohort of Kenyan children receiving HAART, and low baseline hemoglobin was an independent risk factor for death.</p>http://www.biomedcentral.com/1471-2431/10/33 |
| spellingShingle | Mbori-Ngacha Dorothy A Richardson Barbra A Farquhar Carey Obimbo Elizabeth M Wamalwa Dalton C Inwani Irene Benki-Nugent Sara John-Stewart Grace Predictors of mortality in HIV-1 infected children on antiretroviral therapy in Kenya: a prospective cohort BMC Pediatrics |
| title | Predictors of mortality in HIV-1 infected children on antiretroviral therapy in Kenya: a prospective cohort |
| title_full | Predictors of mortality in HIV-1 infected children on antiretroviral therapy in Kenya: a prospective cohort |
| title_fullStr | Predictors of mortality in HIV-1 infected children on antiretroviral therapy in Kenya: a prospective cohort |
| title_full_unstemmed | Predictors of mortality in HIV-1 infected children on antiretroviral therapy in Kenya: a prospective cohort |
| title_short | Predictors of mortality in HIV-1 infected children on antiretroviral therapy in Kenya: a prospective cohort |
| title_sort | predictors of mortality in hiv 1 infected children on antiretroviral therapy in kenya a prospective cohort |
| url | http://www.biomedcentral.com/1471-2431/10/33 |
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