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Short-term mortality and implementation of antiretroviral treatment for critically ill HIV-infected children in a developing country
  1. C Cowburn1,
  2. M Hatherill2,
  3. B Eley1,
  4. J Nuttall1,
  5. G Hussey1,
  6. L Reynolds2,
  7. Z Waggie2,
  8. L Vivian3,
  9. A Argent2
  1. 1Infectious Diseases Clinic, Red Cross Children’s Hospital and University of Cape Town, Cape Town, South Africa
  2. 2Paediatric Intensive Care Unit, Red Cross Children’s Hospital and University of Cape Town, Cape Town, South Africa
  3. 3Primary Health Care Directorate, Red Cross Children’s Hospital and University of Cape Town, Cape Town, South Africa
  1. Correspondence to:
    Dr C Cowburn
    School of Child and Adolescent Health, University of Cape Town, Clinical Investigation Unit S4, Red Cross Children’s Hospital, Klipfontein Road, Cape Town, 7700, South Africa; ccowburn{at}gmail.com

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.

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%; 95% CI 65 to 85%) survived to PICU discharge, but hospital survival was only 51% (95% CI 40 to 63%). Limitation of intervention (LOI) decisions were a factor in the majority of PICU and ward deaths. Twenty one PICU survivors (31%; 95% CI 20 to 42%) commenced HAART, and two children were already on treatment. Nineteen children (28%) were considered to be established on HAART after 1 month. Thirteen HIV-infected children (19%; 95% CI 10 to 28%), representing 25% (95% CI 14 to 37%) of all PICU survivors, and 68% (95% CI 48 to 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.

  • CDC, Centers for Disease Control and Prevention
  • CPR, cardiopulmonary resuscitation
  • EFV, efavirenz
  • HAART, highly active antiretroviral therapy
  • IDC, infectious diseases clinic
  • LOI, limitation of intervention
  • LRTI, lower respiratory tract infection
  • NNRTI, non-nucleoside reverse transcriptase inhibitor
  • NRTI, nucleoside reverse transcriptase inhibitor
  • PICU, paediatric intensive care unit
  • PMTCT, prevention of mother-to-child transmission
  • SMT, standardised mortality ratio

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Footnotes

  • Funded by a self-initiated research grant from the Medical Research Council of South Africa (MH).

  • Competing interests: None.

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