Short-term mortality and implementation of antiretroviral treatment for critically ill HIV-infected children in a developing country

Carol Ann Cowburn ^1*, Mark Hatherill ², Brian Eley ³, James Nuttall ³, Gregory Hussey ², Louis Reynolds ³, Zainab Waggie ³, Lauraine Vivian ² and Andrew Argent ³

¹ University of Cape Town and Red Cross Children's Hospital, South Africa
² University of Cape Town, South Africa
³ Red Cross Children's Hospital, South Africa

^* To whom correspondence should be addressed. E-mail: ccowburn{at}ich.uct.ac.za.

Accepted 21 April 2006

Abstract

Objective: To describe the short-term outcome of critically ill HIV-infected children with access to highly active antiretroviral therapy (HAART) in a developing region.

Methods: Prospective observational study conducted in a paediatric teaching hospital in Cape Town, South Africa. All children admitted to the paediatric intensive care unit (PICU) with suspected HIV infection were screened. Data are n (%) with 95% confidence intervals (CI).

Results: Sixty-eight of 96 HIV antibody positive children, median age 3 months, were confirmed HIV- infected. Predicted PICU mortality was 0.42. Fifty-one children (75%; CI 65 - 85%) survived to PICU discharge, but hospital survival was only 51% (CI 40 - 63%). Limitation of intervention (LOI) decisions were a factor in the majority of PICU and ward deaths. Twenty-one PICU survivors (31%; CI 20 - 42%) commenced HAART, and 2 children were already on treatment. Nineteen children (28%) were considered to be established on HAART after 1 month. Thirteen HIV-infected children (19%; CI 10 - 28%), representing 25% (CI 14 - 37%) of all PICU survivors, and 68% (CI 48 - 89%) of those PICU survivors who were established on HAART, remain well on treatment after median 350 days.

Conclusion: The majority of HIV-infected children survived to discharge from PICU, but only half survived to hospital discharge. LOI decisions, usually made in PICU, directly influenced short-term survival and the opportunity to commence HAART. Although few critically ill HIV-infected children survived to become established on HAART, the long-term outcome of children on HAART is encouraging and warrants further investigation.

Keywords: HAART, HIV, developing country, mortality, survival

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