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Background

This study examines the mortality trends among HIV-infected and uninfected children in Masaka District, Uganda, over an 8-year follow-up period. It aims to understand the impact of HIV on child mortality and identify risk factors associated with high mortality rates among HIV-infected children. Notable findings include significantly higher mortality for children not on antiretroviral therapy (ART) and the importance of early ART initiation. The study highlights the need for comprehensive care approaches, including nutritional support, alongside ART to improve outcomes.

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Background

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Presentation Transcript

  1. Mortality of HIV-infected and uninfected children in a longitudinal clinical cohort in rural southwest Uganda during 8 years of follow-up, 2002-2009 Munyagwa M,1Baisley K,2 Levin J,1 Atuhumuza E,1 Nalaaki M,1 Nakibuuka G,1 Nalugya M,1 Grosskurth H,1,2 Maher D 1,2 1 MRC/UVRI Uganda Research Unit on AIDS 2London School of Hygiene and Tropical Medicine

  2. Background • HIV infection is a leading cause of death among children in developing countries • Care of HIV-infected children poses a great challenge • Early initiation of ART has been found effective in reducing mortality • Impact of early ART initiation in rural Africa requires measurement of baseline mortality

  3. Objectives • To determine the impact of HIV infection on child mortality • To identify risk factors for mortality among HIV-infected children

  4. The study setting Masaka District, southwest Uganda 4

  5. Methods • Participants in 3 categories: HIV-infected, HIV-exposed and uninfected, and HIV-unexposed children aged 6 m to 15 y • Enrolled in a longitudinal clinical cohort from a larger population cohort, July 02 – Aug 09 • Cotrimoxazole prophylaxis since 2002 • ART since 2005 • Clinical and lab data were collected on routine follow-up every 3 months

  6. Methods

  7. Methods

  8. Methods • Person years (pyrs) at risk were calculated from time of enrolment until earliest date of ART initiation, death or last clinic visit • Cox proportional hazards regression was used to estimate hazard ratios (HR) for mortality

  9. Characteristics at enrolment

  10. Characteristics of children on ART

  11. Outcomes by HIV status *Includes 41 children eligible for ART **Includes 31 children initiating ART

  12. Mortality rates by HIV status *Includes 38 person-years in 41 children who were eligible for ART but not on it

  13. Survival curves by HIV status and age at enrolment

  14. Risk factors for mortality among HIV-infected children not on ART *Adjusted HR represents increase in risk of mortality for a one unit decrease in CD4 category.

  15. Risk factors for mortality among all HIV-infected children *Adjusted HR represents increase in risk of mortality for a one unit decrease in CD4 category.

  16. Discussion (1) • Findings • confirm much higher mortality among HIV-infected children not on ART than among HIV-uninfected children • provide baseline to monitor impact of early ART initiation on mortality • Among HIV-infected children not on ART, mortality was highest in those less than 2 years old as found elsewhere, due to more rapid disease progression. • Mortality among HIV-infected children not on ART may be higher outside research settings.

  17. Discussion (2) • Chronic malnutrition and severe anaemia are associated with disease progression, thus increasing risk of mortality. • The lack of an association between ART and decreased mortality may be because of delays in starting ART and the small numbers treated so far.

  18. Recommendations • Monitoring mortality is important to determine success of ART. • Decreased mortality requires intensive efforts to prevent mother to child transmission of HIV and to promote early infant HIV diagnosis and treatment. • In addition to ART, management of HIV-infected children should include nutritional support and prevention and management of anemia.

  19. Acknowledgements Study participants and guardians Staff Collaborating departments MRC (UK) for funding

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