Predictors of Mortality and Mortality Rate in a Cohort of Children Living with HIV from India.

Abstract

To study the predictors of mortality and mortality rate in a clinical cohort of Children Living with Human Immunodeficiency Virus infection (CLHIV) from India. This retrospective cohort analysis of CLHIV aged between 2mo and 18y 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. 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 < 5y, 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 <5y, baseline WHO clinical stage 3 and 4, severe immune suppression and severe malnutrition were strongly associated with mortality. 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.