697 
Mortality and Hospitalization Rate of HIV-infected Children after Receiving HAART
Linda Aurpibul*, T Puthanakit, T Sirisanthana, and V Sirisanthana
Chiang Mai Univ, Thailand
Background: The natural
history of HIV disease in children has altered since expanded use of HAART.
This study aimed to determine the effect of HAART on mortality and
hospitalization rates among HIV-infected children.
Methods:
A
retrospective cohort study. Eligibility
criteria were HIV-infected children aged <18 years, CD4 percentage of £15%
prior to treatment and have been follow-up for >24 weeks. Demographic data, duration of HAART, causes of
hospital admission, CD4 lymphocyte count and percentage, plasma RNA level prior
to and after initiation of treatment were obtained. The primary outcomes are
mortality and hospitalization rates. The secondary outcomes are causes of death
and hospitalization.
Results:
From
August 2002 to March 2005, 192 children were initiated non-nucleoside reverse
transcriptase inhibitor (NNRTI)-based
treatment regimen. The mean age was 9.6 years
(range, 0.6 to 17.8). At baseline, the mean CD4 cell percentage was 5.2% (SD 4.9),
mean CD4 cell count was 171 cells/mL (SD 289) and the mean plasma RNA level was 5.4 log10
copies/mL (SD 0.5). The mean duration on HAART was
107 weeks (SD 40). Mortality and hospitalization rates in each 24-week interval
after initiation of HAART are shown in the table. At the median time of 7 weeks,
13 children died (range 2 to 74). The causes of death were 5 (39%)
opportunistic infections, 5 (39%) sepsis, 2 (15%) pneumonia, and 1(7%)
diarrhea. Most death (69%) occurred within the first 12 weeks
after initiation of HAART. The common causes of hospitalization were pneumonia
(30 episodes) and opportunistic infections (19 episodes). The median length of
stay was 7 days (range, 1 to 81). There was a significant higher baseline plasma
RNA level (5.5±0.4 vs 5.3±0.6 log10 copies/mL, p = 0.04) in
the group of children who died or required hospitalization than the group who
required no hospitalization. The baseline CD4 lymphocyte count was also lower
in the former than the latter group but not statistically significant (130±208 vs 192±323 cells/mL, p = 0.16).
|
Time after
HAART (weeks)
|
0-24
|
25-48
|
49-72
|
73-96
|
97-120
|
121-144
|
|
Total number of children (cases)
Number of children died (cases)
6-month mortality rate (%)
Number of hospitalization (episodes)
6-month hospitalization rate (%)
|
192
11
5.7
60
31.3
|
179
1
0.5
17
9.5
|
170
0
0
13
7.6
|
150
1
0.7
11
7.3
|
134
0
0
1
1.1
|
98
0
0
2
2.0
|
Conclusions: HAART has
significantly reduced mortality and hospitalization rates in children after 24
weeks of treatment.
|
