Predictors of Mortality among Untreated HIV-infected Children
The
adoption of highly active antiretroviral
therapy (HAART) has dramatically reduced disease progression and death among
HIV-infected children in North America and Europe,
but effective combination therapy is less widely available in resource-limited
countries.
As
reported in the January 2, 2008 issue of AIDS, investigators with the Cross
Continents Collaboration for Kids (3Cs4kids) performed a meta-analysis of the
prognostic value of various laboratory and growth markers in predicting short-term
mortality risk among children with HIV/AIDS in such settings
The authors
analyzed individual longitudinal data for children aged 12 months or older from
10 studies (9 African, 1 Brazilian) in the 3Cs4kids collaboration. The risk of
death within 12 months based on age and the most recent laboratory and growth
measurements was estimated using Poisson regression models. Data were adjusted
for use of trimethoprim/sulfamethoxazole (TMP-SMX, also known as cotrimoxazole)
prophylaxis to prevent opportunistic infections.
Results
•
A total of 2510 children contributed 357 deaths during
3769 person-years at risk (81% of follow-up occurred after the start of TMP-SMX
prophylaxis).
•
At first measurement, the median age was 4 years (interquartile
range 2-7), the median CD4 percentage was 15%, and the median weight-for-age z-score
was -1.9 (indicating that the children were below normal weight for their age).
•
CD4 percentage and CD4 cell count were the strongest predictors
of mortality, followed by weight-for-age and hemoglobin level.
•
After adjusting for these markers, the effects of total
lymphocyte count and body mass index (BMI)-for-age were relatively small.
•
Young children (particularly those aged 1-2 years) who
were both severely malnourished and anemic had a high rate of mortality regardless
of CD4 values.
•
However, high CD4 percentage or CD4 cell count values
predicted low mortality level among children older than 5 years and among younger
children with neither severe malnutrition nor anemia.
Conclusion
In
conclusion, the study authors wrote, "CD4 measurements are the most important
indicator of mortality, and wider access to affordable tests is needed in resource-limited
settings."
"Evaluation of antiretroviral initiation in children
also needs to consider weight-for-age and hemoglobin," they added. "Prevention
and treatment of malnutrition and anemia is integral to HIV pediatric care and
could improve survival."
1/29/08
Reference Cross
Continents Collaboration for Kids (3Cs4kids) Analysis and Writing Committee. Markers
for predicting mortality in untreated HIV-infected children in resource-limited
settings: a meta-analysis. AIDS 22(1): 97-105. January 2, 2008.
The
adoption of 
