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Outcome of HIV-exposed uninfected children undergoing surgery
Jonathan S Karpelowsky1, Alastair J W Millar, Nelleke van der Graaf
1Department of Pediatric Surgery, Red Cross War Memorial Children's Hospital, School of Child and Adolescent Health, University of Cape Town, South Africa. jonathk2@chw.edu.au
Insights
Children exposed to HIV but uninfected (HIVe) face increased surgical risks, including higher complication and mortality rates compared to unexposed children. Their outcomes are still better than those of HIV-infected children.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
- Immunology
Background:
- HIV-exposed uninfected (HIVe) children represent a growing population with potential health vulnerabilities.
- Previous research suggests HIVe children may experience increased illness risk compared to HIV-unexposed (HIVn) children.
Purpose of the Study:
- To investigate and compare the morbidity and mortality rates of HIVe children versus HIVn and HIV-infected (HIVi) children following general surgical procedures.
Main Methods:
- A prospective study included 365 children under 60 months undergoing general surgery.
- Children received age-definitive HIV testing.
- Postoperative outcomes including complications, length of stay, and mortality were tracked.
Main Results:
- HIVe children (n=38) experienced higher complication rates (23.7%) and mortality (5.2%) compared to HIVn children (n=245; 5.7% and 0%, respectively).
- HIVe children had a longer hospital stay than HIVn children (3 vs. 2 days).
- Complication rates were similar between HIVe and HIVi children (41.5%).
Conclusions:
- HIVe children exhibit increased risks of complications and mortality after general surgery compared to HIVn children.
- Despite increased risks, HIVe children have a lower complication rate than HIVi children.
Background:
HIV-exposed uninfected (HIVe) children are a rapidly growing population that may be at an increased risk of illness compared to HIV-unexposed children (HIVn). The aim of this study was to investigate the morbidity and mortality of HIVe compared to both HIVn and HIV-infected (HIVi) children after a general surgical procedure.
Methods:
A prospective study of children less than 60 months of age undergoing general surgery at a paediatric referral hospital from July 2004 to July 2008 inclusive. Children underwent age-definitive HIV testing and were followed up post operatively for the development of complications, length of stay and mortality.
Results:
Three hundred and eighty children were enrolled; 4 died and 11 were lost to follow up prior to HIV testing, thus 365 children were included. Of these, 38(10.4%) were HIVe, 245(67.1%) were HIVn and 82(22.5%) were HIVi children.The overall mortality was low, with 2(5.2%) deaths in the HIVe group, 0 in the HIVn group and 6(7.3%) in the HIVi group (p = 0.0003). HIVe had a longer stay than HIVn children (3 (2-7) vs. 2 (1-4) days p = 0.02). There was no significant difference in length of stay between the HIVe and HIVi groups. HIVe children had a higher rate of complications compared to HIVn children, (9 (23.7%) vs. 14(5.7%) (RR 3.8(2.1-7) p < 0.0001) but a similar rate of complications compared to HIVi children 34 (41.5%) (RR = 0.6 (0.3-1.1) p = 0.06).
Conclusion:
HIVe children have a higher risk of developing complications and mortality after surgery compared to HIVn children. However, the risk of complications is lower than that of HIVi children.
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