Paper # 856 
Causes of Hospitalization for HIV+ Children: Comparison of the Pre-PCP Prophylaxis, Pre-ART, and ART Era
Tavitiya Sudjaritruk*1, L Aurpibul2, T Puthanakit2, T Sirisanthana2, and V Sirisanthana2
1Faculty of Med, Chiang Mai Univ, Thailand and 2Res Inst for Hlth Sci, Chiang Mai Univ, Thailand
Background: The Thai HIV/AIDS epidemic has entered
its second decade. As of July 2009, there were 352,424 Thais living with
HIV of which 16,853 (4.8%) were children. To identify demographic
characteristics and causes of hospitalization of HIV-infected children admitted
to Chiang Mai University (CMU) hospital during 1989 to 2008.
Methods: Data were extracted from medical records
and stratified into 3 periods; pre-PCP prophylaxis (first case-1995),
pre-antiretroviral therapy (pre-ART) (1996 to 2002), and ART era (2003 to 2008).
The commonly used regimen composed of 2 NRTI plus one NNRTI. The cause that was
most likely associated with presenting symptoms was selected as his/her cause
of hospitalization. Only the first hospitalization of each child was included
in the analysis.
Results: A total of 1,112 perinatally-acquired
HIV-infected children were hospitalized. Median age was 1.2 years (IQR 0.3 to 4
years). The median age had shifted toward older age in recent years. Of the
1,112 causes, 799 (71.9%) were AIDS-defining illnesses (ADI) and 313 (28.1%)
were non-ADI. ADI included 653 (81.7%) opportunistic infections (OI), 131
(16.4%) non-opportunistic infections (non-OI) and 15 (1.9%) immune restoration
syndromes (IRS). Among 653 OI, PCP, severe bacterial infections, and
systemic fungal infections were the leading causes (Table1).
Table1: Distribution of 653 opportunistic infections
|
Opportunistic infections
|
1989-1995
n %
(N=302)
|
1996-2002
n %
(N=288)
|
2003-2008
n (%)
(N=63)
|
p-value
|
|
PCP
|
109 (36.1)
|
101 (35.1)
|
9 (14.3)
|
0.002
|
|
Bacterial pneumonia
|
47 (15.6)
|
48 (16.7)
|
8 (12.7)
|
0.729
|
|
Severe bacterial infection
|
53 (17.5)
|
28 (9.7)
|
5 (7.9)
|
0.008
|
|
Systemic fungal infection
|
16 (5.3)
|
40 (13.9)
|
5 (7.9)
|
0.001
|
|
CMV infection
|
21 (7.0)
|
12 (4.1)
|
7 (11.1)
|
0.082
|
|
Mycobacterial spp. infection
|
10 (3.3)
|
15 (5.2)
|
9 (14.3)
|
0.002
|
|
Dual infections
|
29 (9.6)
|
14 (4.9)
|
11 (17.5)
|
0.002
|
|
Other infections
|
17 (5.6)
|
30 (10.4)
|
9 (14.3)
|
0.015
|
Of 131 non-OI, chronic lung diseases, hematological causes,
and neurological causes were predominant. There were commonly found in all
three periods. Since the ART era, 15 hospital admissions were caused by severe
IRS. Most of them (10/15) were associated with Mycobacterium spp.
infection. Death rate decreased over time (38.1%, 23.8%, and 12.2%).
Conclusions: Hospitalization rate dramatically
decreased in the ART era. Older children with better outcome were seen in
recent years. PCP and severe bacterial infection decreased, while mycobacterial
infection increased over time.
|
