risk factors associated with increased mortality among hiv infected children initiating antiretroviral therapy (art) in south africa风险因素与死亡率增加有关hiv感染儿童开始抗逆转录病毒疗法(art)在南非.pdfVIP

Risk Factors Associated with Increased Mortality among HIV Infected Children Initiating Antiretroviral Therapy (ART) in South Africa 1,2,3 3 3 3 1,4 Brian C. Zanoni , Thuli Phungula , Holly M. Zanoni , Holly France , Margaret E. Feeney * 1The Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology, and Harvard, Charlestown, Massachusetts, United States of America, 2 Harvard Medical School, Boston, Massachusetts, United States of America, 3 Sinikithemba Clinic and Philani Program, McCord Hospital, Durban, South Africa, 4 Division of Experimental Medicine, University of California San Francisco, San Francisco, California, United States of America Abstract Objective: To identify demographic and clinical risk factors associated with mortality after initiation of antiretroviral therapy (ART) in a cohort of human immunodeficiency (HIV) infected children in KwaZulu-Natal, South Africa. Methods: We performed a retrospective cohort study of 537 children initiating antiretroviral therapy at McCord Hospital in KwaZulu-Natal, South Africa. Data were extracted from electronic medical records and risk factors associated with mortality were assessed using Cox regression analysis. Results: Overall there were 47 deaths from the cohort of 537 children initiating ART with over 991 child-years of follow-up (median 22 months on ART), yielding a mortality rate of 4.7 deaths per 100 child years on ART. Univariate analysis indicated that mortality was significantly associated with lower weight-for-age Z-score (p,0.0001), chronic diarrhea (p = 0.0002), lower hemoglobin (p = 0.002), age ,3 years (p = 0.003), and CD4% ,10% (p = 0.005). The final multi