Predictors of Mortality Among Children and Adolescents Living With HIV on Antiretroviral Therapy in Western Kenya.

Autor:	Nyandiko W; Department of Child Health and Paediatrics, Moi University School of Medicine, Eldoret, Kenya.; Academic Model Providing Access to Healthcare, Eldoret, Kenya., Enjema NA; Department of Child Health and Paediatrics, Moi University School of Medicine, Eldoret, Kenya.; Academic Model Providing Access to Healthcare, Eldoret, Kenya., Mugo R; Academic Model Providing Access to Healthcare, Eldoret, Kenya., Apondi E; Academic Model Providing Access to Healthcare, Eldoret, Kenya.; Directorate of Paediatrics, Moi Teaching and Referral Hospital Eldoret, Kenya; and., Sang E; Academic Model Providing Access to Healthcare, Eldoret, Kenya., Mwangi A; Academic Model Providing Access to Healthcare, Eldoret, Kenya.; Department of Mathematics, Physics and Computing, Moi University Eldoret, Kenya.
Jazyk:	angličtina
Zdroj:	Journal of acquired immune deficiency syndromes (1999) [J Acquir Immune Defic Syndr] 2024 Apr 01; Vol. 95 (4), pp. 383-390.
DOI:	10.1097/QAI.0000000000003361
Abstrakt:	Background: Antiretroviral therapy (ART) has decreased HIV-attributable deaths; however, children and adolescents continue to have high HIV-associated mortality. Setting: We determined the predictors of death among children and young adolescents living with HIV (CALWH) who died while in care in Western Kenya. Methods: This retrospective case-control study used electronically abstracted data of 6234 CALWH who received care in Academic Model Providing Access to Healthcare HIV clinics in Western Kenya between January 2002 and November 2022. The cases comprised CALWH who were reported dead by November 2022, while the controls constituted of matched CALWH who were alive and in care. Independent predictors of mortality were determined using univariable and multivariable Cox proportional hazard regression models. Kaplan-Meier analysis ascertained survival. Results: Of the 6234 participants enrolled, slightly more than half were male (51.7%). The mean (SD) age at the start of ART was significantly lower in cases than in controls at 6.01 (4.37) and 6.62 (4.11) ( P < 0.001), respectively. An age of 11 years or older at start of ART (adjusted Hazard Ratio [aHR]: 8.36 [3.60-19.40]), both parents being alive (aHR: 3.06 [1.67-5.60]), underweight (aHR: 1.82 [1.14-2.92]), and World Health Organization stages 3 (aHR: 2.63 [1.12-6.18]) and 4 (aHR: 2.20 [0.94-5.18]) increased mortality; while school attendance (aHR: 0.12 [0.06-0.21]), high CD4 + counts >350 cells/mm 3 (aHR: 0.79 [0.48-1.29]), and low first viral load <1000 copies/mL (aHR: 0.24 [0.14-0.40]) were protective. Conclusion: Independent predictors of mortality were age 11 years or older at the start of ART, orphan status, underweight, and advanced HIV disease. Beyond the provision of universal ART, care accorded to CALWH necessitates optimization through tackling individual predictors of mortality. Competing Interests: The authors have no funding or conflicts of interest to disclose. (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)
Databáze:	MEDLINE
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