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Morbidity among human immunodeficiency virus-1-infected and -uninfected African children
T E Taha1, S M Graham, N I Kumwenda
1Infectious Diseases Program, Department of Epidemiology, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, Maryland, USA.ttaha@jhsph.edu
Insights
Human immunodeficiency virus (HIV)-infected African children experienced significantly higher morbidity and mortality rates. Rapid disease progression necessitates urgent development of effective management strategies to reduce illness in these vulnerable children.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Human immunodeficiency virus (HIV) infection presents unique challenges in pediatric populations, particularly in resource-limited settings.
- Understanding morbidity patterns is crucial for effective management and improved outcomes in HIV-exposed and HIV-infected children.
Purpose of the Study:
- To investigate and compare the patterns of morbidity and mortality in HIV-infected versus HIV-uninfected African children during late infancy and early childhood.
- To identify factors associated with increased morbidity and mortality in this cohort.
Main Methods:
- A prospective study was conducted in Malawi, following children from infancy to approximately 36 months of age.
- Morbidity and mortality data were collected via questionnaires every 3 months, with physical examinations every 6 months.
- Age-adjusted and Kaplan-Meier analyses were used to compare outcomes between HIV-infected and HIV-uninfected children.
Main Results:
- HIV-infected children exhibited significantly higher age-adjusted morbidity rates compared to HIV-uninfected children.
- By age 3, 89% of HIV-infected children had died, with conditions like splenomegaly, oral thrush, and developmental delay predicting mortality.
- Immunization rates were generally high across all groups, but HIV-infected children showed greater immunosuppression.
Conclusions:
- The study highlights a high frequency of diseases and a rapid progression from HIV disease to death in infected children.
- There is a critical need for management strategies to effectively reduce morbidity and improve survival in HIV-infected children.
- Early identification and intervention for conditions like oral thrush and developmental delay are vital for improving prognosis.
Objective:
To assess patterns of morbidity and associated factors in late infancy and early childhood among human immunodeficiency virus (HIV)-infected and -uninfected African children.
Design:
Prospective study.
Setting:
The Queen Elizabeth Central Hospital, Blantyre, Malawi.
Participants:
Children with known HIV status from an earlier perinatal intervention trial were enrolled during the first year of life and followed to approximately 36 months of age.
Outcome Measures:
Morbidity and mortality information was collected every 3 months by a questionnaire. A physical examination was conducted every 6 months. Blood to determine CD4(+) values was also collected. Age-adjusted and Kaplan-Meier analyses were performed to compare rates of morbidity and mortality among infected and uninfected children.
Results:
Overall, 808 children (190 HIV-infected, 499 HIV-uninfected but born to infected mothers, and 119 born to HIV-uninfected mothers) were included in this study. Of these, 109 died during a median follow-up of 18 months. Rates of childhood immunizations were high among all children (eg, lowest was measles vaccination [87%] among HIV-infected children). Age-adjusted morbidity rates were significantly higher among HIV-infected than among HIV-uninfected children. HIV-infected children were more immunosuppressed than were uninfected children. By 3 years of age, 89% of the infected children died, 10% were in HIV disease category B or C, and only approximately 1% were without HIV symptoms. Among HIV-infected children, median survival after the first occurrence of acquired immunodeficiency syndrome-related conditions, such as splenomegaly, oral thrush, and developmental delay, was <10 months. These same conditions, in addition to frequent bouts of fever, were the main morbidity predictors of mortality.
Conclusions:
The frequency of diseases was high, and progression from asymptomatic or symptomatic HIV disease to death was rapid. Management strategies that effectively reduce morbidity for HIV-infected children are needed.