Mortality in pediatric HIV: causes and contributing factors in the P2C2 study ♦ 732

Abstract

A multicenter longitudinal study to assess the natural history of cardiac and pulmonary complications of vertically transmitted HIVenrolled 806 infants of HIV+ mothers. 205 were HIV+ at enrollment (I), 601 were enrolled prenatally or immediately postnatally; of this latter group 92 (15.3%) became HIV+ (IIa), 454 HIV- (IIb), and HIVstatus is unknown for 55 (IIi). There have been 105 deaths in study patients. Only 33/105 (31%) had autopsies. Because of the low autopsy rate and the need to determine cause of death in all, a multidisciplinary committee reviewed and categorized all deaths. Review is complete in 71/105 (68%). Nineteen deaths were in infants 5. Fifty-eight deaths were HIV related, 9 were not, in 4 there was insufficient information to categorize death. Of the 58 HIVrelated deaths, 8 were in infants 5. For the youngest, 6/8 had infectious deaths, 2/8 hemorrhagic. Contributing factors included chronic pulmonary disease and chronic cardiac disease in one each; none had MAI or encephalopathy. Of deaths between 1 and 5 years 18/34 were infectious, 6/34 wasting, 3/34 cardiac, 2 each pancreatitis, encephalopathy, and tumor (a third with malignancy had an infectious death), and 1 with DIC. Contributing factors included 20/34 chronic lung disease, 18/34 chronic cardiac disease (11 both), 13/34 MAI, 10/34 encephalopathy, and 24/34 wasting. Of the oldest (>5 years) 7/16 had infectious deaths, 4/16 cardiac, 3/16 wasting, 1/16 organ failure and 1/16 encephalopathy. Contributing factors included 8/16 chronic lung disease, 9/16 chronic cardiac disease (5/16 both), 8/16 MAI, 5/16 encephalopathy, 15/16 wasting. In conclusion, infectious deaths were common, 31/58 (53%), more so in younger children; non-infectious deaths included 7/58 (12%) cardiac, more frequent in older children. Wasting, MAI, and encephalopathy all increased with age as primary and contributory causes of death with wasting being nearly universal in older children. Evidence of chronic cardiac and pulmonary disease also increased with age; chronic cardiac disease was seen in 28/58 (48%) and 29/58(50%) had chronic lung disease.