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Characteristics of HIV-infected children seen in Western Kenya
W M Nyandiko1, A Mwangi, S O Ayaya
1Department of Child Health and Paediatrics, School of Medicine, Moi University, Eldoret, Kenya.
Insights
This study of 4017 HIV-infected children in Western Kenya found that early enrollment improved outcomes. Combination antiretroviral therapy (cART) was effective, with lower loss to follow-up rates in children receiving treatment.
Area of Science:
- Paediatrics
- Infectious Diseases
- Public Health
Background:
- HIV infection remains a significant global health challenge, particularly in resource-limited settings.
- Paediatric HIV care requires comprehensive management, including early diagnosis, treatment, and prevention of opportunistic infections.
- Western Kenya has a high burden of HIV, necessitating robust care programs for affected children.
Purpose of the Study:
- To characterize the demographics, clinical presentation, and treatment outcomes of HIV-infected children in Western Kenya.
- To evaluate the effectiveness of combination antiretroviral therapy (cART) and identify factors influencing outcomes.
- To inform public health strategies for improving paediatric HIV care in similar settings.
Main Methods:
- A retrospective descriptive study was conducted on 4017 HIV-infected children under 15 years old.
- Data were collected from USAID-AMPATH HIV clinics in Western Kenya between June 2002 and April 2008.
- Key outcome measures included diagnosis, clinical and immune status, opportunistic infections, hospitalizations, mortality, and response to cART.
Main Results:
- The median age at enrollment was 4 years, with a significant proportion of orphaned children (25% paternal, 10% total, 13% maternal).
- Malnutrition (low Weight-for-Age Z scores) was prevalent, especially in orphaned children (p=0.0001).
- Common presenting conditions included cough, gastroenteritis, fever, and pneumonia; only 25% received cotrimoxazole preventive therapy (CPT).
- While 64% were on cART, initiation was often delayed; however, cART improved CD4% and reduced loss to follow-up (19% vs. 37% for those not on cART).
- Overall mortality was 6%, with higher rates of hospitalization (34%) and pneumonia (41%) reported.
Conclusions:
- HIV-infected children in Western Kenya presented with significant challenges, including malnutrition and advanced disease, particularly among orphans.
- Early initiation of cART, despite delays, demonstrated positive impacts on immune status and retention in care.
- Improved access to CPT and timely cART initiation are crucial for better outcomes in paediatric HIV management.
Objectives:
To describe the characteristics and outcomes of children registered for care in a large HIV care programme in Western Kenya.
Design:
A retrospective descriptive study.
Setting:
USAID-AMPATH HIV clinics in health centres; district and sub-district hospitals; Moi Teaching and Referral Hospital in Western Kenya.
Subjects:
HIV-infected children below age of 15 years seen in a network of 18 clinics in Western Kenya.
Interventions:
Paediatric HIV diagnosis and care including treatment and prevention of opportunistic infections and provision of combination antiretroviral therapy (CART).
Main Outcome Measures:
Diagnosis, clinical stage and immune status at enrollment and follow-up; hospitalisation and death. Descriptive statistical analyses and chi square tests were performed.
Results:
Four thousand and seventeen HIV-infected children seen between June 2002 and April 2008. Median age at enrollment was four years (0-14.2 years), 51% girls, 25% paternal orphans, 10% total orphans and 13% maternal orphans. At enrollment, 25% had weight-for-Age Z scores (WAZ) > or = -1 and 21% had WAZ scores < or = 3. Orphaned children had worse WAZ scores (p=0.0001). Twenty five per cent of children were classified as WHO clinical stage 3 and 4, 56% were WHO clinical stages 1 and 2 with 19% missing clinical staging at enrollment. Cough (25%), gastroenteritis (21%), fever (15%), pneumonia (10%) were the commonest presenting features. Twenty six per cent had been diagnosed with tuberculosis and only 25% started on cotrimoxazole preventive therapy (CPT). Median CD4% at enrollment was 16% (0-64%); latest recorded values were 22% (0-64). Sixty four per cent were on cART (cART+), median age at start was 5.4 (014.4 years). The median initial CD4% among cART+ was 13 (0-62) compared to 24 (0-64) for those not on ART (cART-). Median CD4% for cART+ improved to 22% (0-59); whereas cART- was 23% (0-64) at last appointment. During the period of follow-up, one fifth (19%) of children on cART were lost to follow-up compared to slightly over one third (37%) for those not on cART. Thirty four percent were hospitalised; 41% diagnosed with pneumonia. Six per cent of 4017 were confirmed dead.
Conclusions:
HIV-infected children were enrolled in care early in childhood. Orphanhood was prevalent in these children as were gastroenteritis, fever, pneumonia and advanced immuno-suppression. Orphans were more likely to be severely malnourished. Only a quarter of children were put on cotrimoxazole preventive therapy. Children commenced on cART late but responded well to treatment. Loss to follow-up was less prevalent among those on cART.
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