Revista de SIDA e investigación clínica

Factors Affecting Survival of HIV Positive Children Taking Antiretroviral Therapy at Adama Referral Hospital and Medical College, Ethiopia

Abstract

Adem Aman Kedir, Alem Desta and Girmatsion Fesseha

Background: The aim of this study is to explore factors affecting survival of children living with HIV/AIDS after initiation of ART. In which it highlights the need for local evidence to promote interventions that optimize survival among HIV-infected children on ART in Ethiopia.

Methods: Institution based retrospective cohort study was employed on 560 children enrolled on ART from January, 2006-December, 2010. Information on relevant variables was collected from patients` medical cards and registries. Univariate analysis was used to describe the baseline characteristics of the patients`. Life table was used to estimate survival after initiation of ART. Log rank test was used to compare survival between different categories of independent variables. Multivariable Cox proportional model was fitted to identify factors affecting survival after initiation of ART.

Results: Children on ART were followed for a median follow up period of 47 months (IQR=29, 62). At the end of follow up, 364 (65%) were alive and 43 (7.6%) were reported dead. More than three fourth of the deaths occurred within the first sixth months of starting ART. The estimated cumulative survival probabilities were 0.939, 0.928, 0.926, 0.923, 0.920, and 0.916 at 6, 12, 18, 36, 48, and 60 months, respectively. Anemia (hemoglobin level<10 gm/dl) (AHR=2.60, 95% CI=1.41, 4.84), absolute CD4 cell count below the threshold for severe immunodeficiency (AHR=3.55, 95% CI 1.48, 8.46), advanced WHO staging (stage IV) (AHR=3.08, 95% CI=1.27, 7.47), and underweight (AHR=2.49, 95% CI 1.27, 4.88) have found to be predictors of mortality after ART initiation.

Conclusions: Mortality was high especially during the first sixth months following ART initiation. Therefore, close follow up of HIV exposed children to make early diagnosis and treatment initiation before the development of severe immune deficiency and advanced clinical stage is important.