Risks and predictors of mortality among human immunodeficiency virus-infected children receiving highly active antiretroviral therapy in Yunnan Province

Abstract

Objective To investigate the influence factors of mortality among human immunodeficiency virus (HIV)-infected children under highly active antiretroviral therapy (HAART). Methods Retrospective cohort study of 652 children initiated HAART from 2005 to 2014 was conducted, and enrolled patients were followed-up until December, 2015. Survival data was analyzed using Kaplan-Meier method and Cox regression model was used to identify independent predictors of mortality among these children on HARRT. Chi-square test and Fisher′s exact test were used for comparison between groups. Results Overall, 26 of the children died over a follow-up period of 3 116.24 child-years, with a mortality rate of 0.83 per 100 child-years. Twelve (46%) of deaths occurred during the first six months after starting HAART. Cox regression analysis of variables showed that the World Health Organization (WHO) clinical stages Ⅲ/Ⅳ (hazard rate [HR]=10.717, 95% confidence interal [95% CI]: 4.189-4.749, P=0.000), baseline hemoglobin <80 g/L (HR=14.768, 95% CI: 5.721-38.125, P=0.000), tuberculosis co-infection (HR=4.794, 95%CI: 2.105-10.918, P=0.000), baseline CD4+ T lymphocyte<50 cells/μL (HR=4.219, 95%CI: 1.524-11.680, P=0.006), weight-for-age z-score <-2 (HR=2.983, 95%CI: 1.094-8.135, P=0.033)were independently associated with death, whereas the age <7 year-old at HAART initiation was protectire (HR=0.293, 95% CI: 0.126-0.684, P=0.005). Conclusions The mortality of children receiving HAART is strongly associated with WHO stages Ⅲ/Ⅳ, hemoglobin <80 g/L, weight-for-age z-score <-2, tuberculosis co-infection and older age at treatment. Key words: Child; Acquired immunodeficiency syndrome; Antiretroviral treatment