PREDICTORS OF MORTALITY IN CHILDREN AND ADOLESCENTS LIVING WITH HIV ON ANTIRETROVIRAL THERAPY, ETHIOPIA: A RETROSPECTIVE COHORT STUDY

Abstract

Background : Treatment of pediatric HIV infection has steadily improved since the introduction of highly active antiretroviral drugs. Knowledge of antiretroviral drugs results is limited and factors contributing to high mortality are poorly investigated in resource-poor settings. So, the aim of this study was to assess independent predictors of mortality in HIV infected children on antiretroviral treatment.
Methods: A retrospective institutional-based cohort study was conducted in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. Children who initiated treatment from 2011 to 2015 at the pediatrics antiretroviral treatment clinic are included. We reviewed the patients chart between June and July 2016. Mortality rates were analyzed using the Kaplan Meier method and Cox proportional hazard model used to identify independent predictors of mortality.

Results: Four hundred ten children included in this analysis, 22 died over a follow-up period of 1103 child-years with mortality rate of 19.9 deaths per 1000 child-years. Hemoglobin level < 9 gm/dl (hazard ratio (HR) = 3.23, 95% CI: 2.06-5.20), CD4 count < 100 cells (HR =2.25, 95% CI: 1.34-3.47), TB at baseline (HR=4.97, 95% CI: 2.06-11.99), advanced WHO stages (HR =2.32, 95% CI: 1.32-4.09), poor adherence for ART (HR=5.16, 95% CI: 2.97-8.97), and nonenrollment in youth support group (HR =2.53, 95% CI: 1.59-4.00) were the independent predictors of mortality.

Conclusion: Mortality observed in these children on antiretroviral treatment is of major concern. Important predictors of mortality are preventable and treatable conditions. The high early mortality rate would support the value of thorough evaluation at baseline and close follow up.