Abstract

Introduction Recognizing the predictors of mortality among HIV-infected children will allow for concerted management that can reduce HIV-mortality in Nigeria. Methodology A retrospective cohort study in children aged 0–15 years, between October 2010 and December 2013, at the Federal Medical Centre, Makurdi, Nigeria. Kaplan–Meier method analysed the cumulative probability of early mortality (EM) occurring at or before 6 months and after 6 months of follow-up (late mortality-LM) on a 12-month antiretroviral therapy (ART). Multivariate Cox proportional regression models were used to test for hazard ratios (HR). Results 368 children were included in the analysis contributing 81 children per 100 child-years to the 12-month ART follow-up. A significant reduction in EM rates was noted at 17.3 deaths per 100 child-years (30 deaths) to LM rates of 3.0 deaths per 100 child-years (10 deaths), p < 0.01. At multivariate analysis, children with a high pretreatment viral load (≥10,000 copies/ml) were found to be at risk of EM (aHR; 18. 089, 95% CI; 2.428–134.77, p=0.005). Having severe immunosuppression at/or before 6 months of ART was the predictor of LM (aHR; 17.28, 95% CI; 3.844–77.700, p ≤ 0.001). Conclusions Although a lower mortality rate is seen at 12 months of ART in our setting, predictors of HIV mortality are having high pretreatment HIV viral load and severe immunosuppression. While primary prevention of HIV infection is paramount, early identification of these predictors among our HIV-infected children for an early ART initiation can reduce further the mortality in our setting. In addition, measures to ensure a good standard of care and retention in care for a sustained virologic suppression cannot be ignored and are hereby underscored.

Highlights

  • Recognizing the predictors of mortality among HIV-infected children will allow for concerted management that can reduce HIV-mortality in Nigeria

  • Without antiretroviral therapy (ART), half of the HIV-infected children tend to die before their 2nd birthday [3,4,5]. e proportion of HIV deaths remains higher in resource-limited countries (RLCs) [6,7,8,9,10,11,12,13] compared to resource-rich countries (RRC) [14,15,16] because of pervasive weak health systems, poor socioeconomic conditions, and a relative suboptimal care for HIV-infected children. e unacceptably high HIV-related mortality in RLCs is linked to the use of suboptimal antiretroviral regimens, nonadherence to ART, ART discontinuation as a result of drug toxicities, and the propensity for resistant viral strains [17]

  • Study Area and Setting. is report is from the paediatric HIV care and treatment (PHCT) programme of the Federal Medical Centre (FMC), Makurdi, which is supported by the AIDS Prevention Initiative in Nigeria (APIN)/Harvard PEPFAR ( e USA President’s Emergency Plan for AIDS Relief). e PHCT had commenced a comprehensive care in May 2006. e details of the study setting have been reported elsewhere [27] as the authors had earlier reported the burden of tuberculosis in the same cohort of HIV-infected children

Read more

Summary

Introduction

Recognizing the predictors of mortality among HIV-infected children will allow for concerted management that can reduce HIV-mortality in Nigeria. A lower mortality rate is seen at 12 months of ART in our setting, predictors of HIV mortality are having high pretreatment HIV viral load and severe immunosuppression. While primary prevention of HIV infection is paramount, early identification of these predictors among our HIV-infected children for an early ART initiation can reduce further the mortality in our setting. Only 12% of Nigerian children (aged 0–14 years) living with HIV received antiretroviral therapy (ART) in 2014 [1]. E unacceptably high HIV-related mortality in RLCs is linked to the use of suboptimal antiretroviral regimens, nonadherence to ART, ART discontinuation as a result of drug toxicities, and the propensity for resistant viral strains [17]. Without ART, half of the HIV-infected children tend to die before their 2nd birthday [3,4,5]. e proportion of HIV deaths remains higher in resource-limited countries (RLCs) [6,7,8,9,10,11,12,13] compared to resource-rich countries (RRC) [14,15,16] because of pervasive weak health systems, poor socioeconomic conditions, and a relative suboptimal care for HIV-infected children. e unacceptably high HIV-related mortality in RLCs is linked to the use of suboptimal antiretroviral regimens, nonadherence to ART, ART discontinuation as a result of drug toxicities, and the propensity for resistant viral strains [17].

Methods
Results
Conclusion
Full Text
Published version (Free)

Talk to us

Join us for a 30 min session where you can share your feedback and ask us any queries you have

Schedule a call