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Mortality and Associated Factors After Initiation of Pediatric Antiretroviral Treatment in the Democratic Republic of the Congo

2008; Lippincott Williams & Wilkins; Volume: 28; Issue: 1 Linguagem: Inglês

10.1097/inf.0b013e318184eeb9

1532-0987

Steven Callens, Nicole Shabani, Jean Lusiama, Patricia Lelo, Faustin Kitetele, Robert Colebunders, Ziya Gizlice, Andrew Edmonds, Annelies Van Rie, Frieda Behets,

HIV-related health complications and treatments

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.