AEGiS-13IAC: Children with early HIV-infection in Abidjan, Cote d'Ivoire: Immunologic and nutritional status, mortality rates, and causes of death.

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

Children with early HIV-infection in Abidjan, Cote d'Ivoire: Immunologic and nutritional status, mortality rates, and causes of death.

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. MoOrB115)

Kamelan-Tano Y, Boni-Ouattara E, Ekpini ER, Sibailly TS, Adjorlolo Johnson G, Diaby L, Krou-Danho N, Kalou Aziz M, Tossou O;;; Y. Kamelan-Tano, Projet Retro-CI, 01 BP 1712, Abidjan 01, Cote D'Ivoire, Tel.: +225 212 541 11, Fax: +225 212 429 69, E-mail: tdk1@cdc.gov

BACKGROUND: 90,000 deliveries occur yearly in Abidjan. With a seroprevalence among pregnant women of 13.8% (1998), a mother-to-child HIV transmission rate of >25%, approximately 3,000 new pediatric infections occur yearly. Few data exist on the clinical course of HIV infection in children in Africa.

OBJECTIVES: To describe mortality and morbidity among HIV-1 infected children in Abidjan.

METHODS: All children born to consenting HIV-1 infected women participating in a randomized zidovudine trial (4/1996-2/1998, 269 deliveries) or receiving open-label zidovudine (2/1998-7/1999, 152 deliveries) at a public antenatal clinic were evaluated at birth, 4 weeks, 3 months, and every 3 months thereafter. Infection in children was defined as a positive HIV-1 PCR, or if age > 15 months, a positive HIV-1 serologic test. Malnutrition was defined as a weight less than two standard deviations from the mean weight-for-age.

RESULTS: Of 411 live-born children with available HIV results, 78 (18.9%) became HIV-1-infected (15 [19%] with first positive test result at birth, 35 [45%] at 4 weeks, 12 [15%] at 3 months, and 16 [21%] later). Median follow-up was 12 months for HIV-1 infected children and 15 months for children who were not infected. Median CD4 cell counts/m l for HIV-1 infected children and noninfected children were: 1955 vs 2409 (p > 0.01) at 6 months, and 1785 vs 2373 at 12 months (p > 0.01). 68% of HIV-infected and 25% of noninfected children were malnourished at 12 months of age (relative risk [RR] 2.7, 95% CI, 1.9-3.7). HIV-infected children had a significantly higher mortality (24 deaths, 31.7/100 person years [PYs]) compared with noninfected children (7 deaths, 1.4/100 PY) (RR 21.8, 95%CI, 9.4-50.5). Mortality rates for HIV-infected children by time of first positive result were: 35.7/100PYs (positive at birth), 36.8/100PYs (first positive at 1 or 3 months), and 12.8/100PYs (first positive after 3 months). Principal causes of death among HIV-infected children were respiratory infections (38%), wasting (17%), and malnutrition (4%).

CONCLUSIONS: Mortality and malnutrition are high among HIV-1 infected children. Interventions are needed to prevent children from becoming HIV-infected, and among those already infected, to improve clinical and nutritional care.

Keywords: AEGIS, HIV Infections, HIV-1, Zidovudine, CD4 Lymphocyte Count, Nutritional Status, HIV Seropositivity, Cote d'Ivoire, Infant Mortality, Mothers, Seroepidemiologic Studies, Africa, Child, Human, Female, Pregnancy, Mortality, immunology
000709
MoOrB115