Risk Factors for Early Mortality in Children on Adult Fixed-Dose Combination Antiretroviral Treatment in a Central Hospital in Malawi

In the current study, a retrospective cohort analysis was performed to determine the cumulative proportion of deaths occurring within three and six months of children under age 15 starting split-tablet adult fixed-dose combination antiretroviral therapy (ART) and to identify risk factors associated with early deaths.

From July 2004 to September 2006, the researchers collected and analyzed data from ART patient master cards and the ART register of all children registered for treatment in the ART clinic at Mzuzu Central Hospital in northern Malawi.

A total of 439 children began ART, of whom 220 (50 percent) were male; 37 (8 percent) were under 18 months of age, 172 (39 percent) 18 months to five years, and 230 (52 percent) were ages six to 14 years. By September 2006, 49 children (11 percent) had died, of whom 35 (71 percent) died by three months and 44 (89 percent) by six months. Cumulative incidence of death at three, six, 12, and 24 months after ART was eight, 12, 13, and 15 percent, respectively. Multivariate analysis showed being in World Health Organization clinical stage 4, having severe wasting and severe deficiency were factors significantly associated with three-month and six-month mortality, respectively.

"Although children do well on ART, there is high early mortality," the researchers concluded. "Scaling up HIV testing and simple diagnostic tests for infants and children, expanding routine provision of cotrimoxazole prophylaxis, and investigating the role of nutritional interventions are three measures that, if implemented and expanded countrywide, may improve ART outcomes."