OBJECTIVE: We aimed to describe factors associated with mortality among children receiving antiretroviral treatment (ART) at a pediatric hospital in Kinshasa, Democratic Republic of the Congo. RESULTS: Two hundred ninety-nine children, <18 years old, were followed for a median of 77 weeks (interquartile range: 61-103) post-ART initiation. Survival probability was 89.6% [95% confidence interval (CI): 85.5-92.6%] at 12 months; 24 of 31 deaths (77.4%) occurred within 2 months of ART initiation. Predictors of mortality in bivariate analysis were >/=2 opportunistic infections before ART initiation, severe immunosuppression as defined by age-specific CD4 count or percentage criteria, hemoglobin <9 g/dL, oral candidiasis, and severe malnutrition. In multivariate analysis, weight for age z-score [hazard ratio (HR): 0.39; 95% CI: 0.27-0.61; P < 0.001] and oral candidiasis (HR: 5.86; 95% CI: 2.34-14.65; P = 0.0002) were independent predictors of mortality. Suspected septic shock was the most common cause of death (n = 12/31, 38.7%). CONCLUSIONS: Children receiving ART in this resource-poor setting were at the highest risk of dying in the first 2 months of ART, particularly when they presented with malnutrition or oral candidiasis. Optimal timing of ART initiation during nutritional rehabilitation should be determined. Promotion of early care seeking, strengthened health care, and prevention services are important to further improve outcome of pediatric ART in resource-poor settings.
OBJECTIVE: We aimed to describe factors associated with mortality among children receiving antiretroviral treatment (ART) at a pediatric hospital in Kinshasa, Democratic Republic of the Congo. RESULTS: Two hundred ninety-nine children, <18 years old, were followed for a median of 77 weeks (interquartile range: 61-103) post-ART initiation. Survival probability was 89.6% [95% confidence interval (CI): 85.5-92.6%] at 12 months; 24 of 31 deaths (77.4%) occurred within 2 months of ART initiation. Predictors of mortality in bivariate analysis were >/=2 opportunistic infections before ART initiation, severe immunosuppression as defined by age-specific CD4 count or percentage criteria, hemoglobin <9 g/dL, oral candidiasis, and severe malnutrition. In multivariate analysis, weight for age z-score [hazard ratio (HR): 0.39; 95% CI: 0.27-0.61; P < 0.001] and oral candidiasis (HR: 5.86; 95% CI: 2.34-14.65; P = 0.0002) were independent predictors of mortality. Suspected septic shock was the most common cause of death (n = 12/31, 38.7%). CONCLUSIONS:Children receiving ART in this resource-poor setting were at the highest risk of dying in the first 2 months of ART, particularly when they presented with malnutrition or oral candidiasis. Optimal timing of ART initiation during nutritional rehabilitation should be determined. Promotion of early care seeking, strengthened health care, and prevention services are important to further improve outcome of pediatric ART in resource-poor settings.
Authors: Bradley C Fetzer; Mina C Hosseinipour; Portia Kamthuzi; Lisa Hyde; Brian Bramson; Kebba Jobarteh; Kristine Torjesen; William C Miller; Irving Hoffman; Peter Kazembe; Charles Mwansambo Journal: Trop Med Int Health Date: 2009-06-28 Impact factor: 2.622
Authors: Bradley C Fetzer; Bavon Mupenda; Jean Lusiama; Faustin Kitetele; Carol Golin; Frieda Behets Journal: AIDS Patient Care STDS Date: 2011-08-08 Impact factor: 5.078
Authors: Dalton Wamalwa; Sarah Benki-Nugent; Agnes Langat; Ken Tapia; Evelyn Ngugi; Jennifer A Slyker; Barbra A Richardson; Grace C John-Stewart Journal: Pediatr Infect Dis J Date: 2012-07 Impact factor: 2.129
Authors: Tin Tin Sint; Ronnie Lovich; Wendy Hammond; Maria Kim; Sara Melillo; Lydia Lu; Pamela Ching; Jennifer Marcy; Nigel Rollins; Emilia H Koumans; Amie N Heap; Margaret Brewinski-Isaacs Journal: AIDS Date: 2013-11 Impact factor: 4.177