Factors associated with short term survival of HIV infected children in Nairobi, Kenya

Abstract

Background and objectives: . There is limited report on natural history of HIV-1 infection in African children, and much more so on long-term observational cohort studies. The literature on natural history may differ from the western world due to lack of anti-retroviral drug use and other infectious disease burdens in the resource poor sub Saharan Africa. From 1986~ a collaborating team of researchers from the University of Nairobi and the University of Manitoba, Canada has been conducting a cohort study on mother-to-child HlV-1 transmission. While following up the children, we noted a sub-group of children who died before reaching 3 years of age. The study objective is to describe the factors .associated with survival of HlV-1 infected children to <3 years. Methods: Data was abstracted from the main study onHlV-1 infected mothers and their children those who were born between 1992 and 1997. The data included maternal socio-demographic and clinical factors at delivery of the index child, the clinical and anthropometrical measurements of the infant at delivery, and clinical and laboratory follow-up evaluation on scheduled visits. Results: There were 52HlV-1 infected children within complete follow-up data from delivery. Twenty-eight of the 52 children (53.8%) died before age 3 years. The mothers and the children had no access to anti-retroviral drugs. Significant factors associated with early mortality included: illnesses during pregnancy with no medical treatment being sought (p 0.02), low birth weight <2500grams (p=0.02), occurrence of diarrhoeal disease as early as 6 weeks of life (P=0.06) and failure to thrive by 6 months (p=0.001). Significantly higher incidences of common signs of HlV-1 infection; fever (P=0.02), cough (p<0.001),diarrhoea (p=0.002) and thrush (p=0.0002) were seen in the children who died before 3 years of age. Conclusion: There was a high (53.8%) mortality in this cohort in the first three years of life. Diarrhoeal disease and failure to thrive were the main factors associated with early mortality in this cohort of children without antiretroviral drug exposture.