Morbidity and Mortality Among HIV -1 Infected Children Receiving Artiretroviral Therapy At The University Teaching Hospital, Lusaka
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The introduction of antiretroviral therapy has transformed HIV care and lead to significant reduction in morbidity and mortality worldwide. In resource poor setting like Zambia, HIV-infected children often start treatment with advanced disease stage against a background of a high burden of infectious diseases. The aim of this study was to investigate the short-term causes of morbidity and mortality among HIV-infected children receiving Anti-retroviral therapy (ART) at the University Teaching Hospital (UTH), Lusaka. Specifically, the study examined the incidences and causes of both morbidity (episodes of ill health requiring hospital attention or hospitalisation) and mortality. The study also identified risk factors for the clinical events in the first six months of treatment. Children who started receiving ART from January to June 2008 were prospectively observed. The patients enrolled in this study were aged between 5 months to 16 years and were followed up for a period of 24 weeks. They were reviewed at 2-weekly intervals in the first month and thereafter at week 8, 12, 20 and 24. At each subsequent visit, each child was assessed for occurrence of new symptoms and signs relating to HIV disease and for other intercurrent illnesses. Relevant investigations were then performed as indicated. One hundred and twenty children were included; ninety-six completed (80%) 24 weeks follow up, six (5%) died, nine (7.5%) were lost to follow-up and two (1.6%) transferred to other treatment centres. The mean age was 4.1 years and sixty-eight percent aged below five years. The mean baseline CD4 count and percentage were 586 cell/uL and 14% respectively. Eighty-four percent were WHO clinical stage 3 or 4, nearly one fifth had haemoglobin below 8 g/dl, and forty percent had weight-for-height z-score below normal. Sixty-seven (55.8%) children reported new episode of ill health at least once, twenty-nine (24.2 %) were admitted a total of 39 times. Two thirds of the illnesses and admission were reported in the first 7 weeks of therapy with peaks between week 2 and 4. Pneumonia, malnutrition, TB and malaria accounted for most admission while acute gastroenteritis, oral candidiasis, and chronic otitis media were the main reasons for outpatient attendance. All the deaths, vii except one death occurred in the first 3 months of treatment. The incidence of morbidly and mortality dropped after the first 3 months of ART. This study shows that there is a high rate of morbidity (57.3%) requiring hospital admission observed in children within the first two to three months of initiating ART. The mortality rates were low (6 %) approximating that observed in other similar settings. Baseline CD4 count, previous history of infections (PCP, TB, chronic gastroenteritis, chronic suppurative otitis media), age one to three years were associated with morbidity while male sex and commencing ART within a week of previous discharge were associated with mortality.