Treatment and outcome of hospitalised, very young, HIV-infected children

Abstract

Objective: To describe the disease severity, clinical course and outcome of hospitalised HIV-infected children aged < 6 months.

Methods: A retrospective case review was completed at Red Cross Children’s Hospital during mid-2006. The perinatal management, disease severity, and hospital outcome were analysed. In a sub-analysis, the disease profile and outcome of admitted children aged less than and greater than 6 months were compared over the latter 3 months of the study.

Results: 75/121(43.86%) of all HIV-infected children admitted over the study period were <6months old. 69/72(95.83%) of the children, not receiving HAART at admission, qualified according to current WHO treatment criteria. The most frequent cause for admission was pneumonia (54.67%). The inpatient fatality rate was 28%; pneumonia being the most frequent cause of death (61.9%).

52/75(69.33%) of the mothers reported being tested for HIV during pregnancy. 34/37(91.89%) who tested HIV-positive during pregnancy received PMTCT prophylaxis. Children with confirmed/presumed PJP were less likely to have mothers who received PMTCT prophylaxis (18.51% vs 61.7% p=0.0004), and less likely to be receiving cotrimoxazole prophylaxis (14.81% vs 46.81% p=0.006) at admission.

Children >6months were more likely to be receiving cotrimoxazole prophylaxis (65.4% vs. 31.1%, p=0.0008) and HAART (42.3% vs. 6.7%, p=0.00007) at the time of admission. Of those not on HAART, 27/30(90%) had WHO stage 3 or 4 disease. In patient fatality in this group was 13.5%.

Conclusions: Young children constitute a sizable proportion of the inpatient paediatric HIV workload. Comprehensive PMTCT interventions and earlier introduction of HAART may reduce morbidity, hospitalisation rates and mortality.