16th International AIDS Conference Toronto, Canada - August 13 - 18, 2006

IMPACT OF HIV STATUS ON PATTERNS OF MORTALITY IN HIV INFECTED SEVERELY MALNOURISHED CHILDREN, ADMITTED TO 3 NUTRITION REHABILITATION UNITS IN THE CENTRAL REGION OF MALAWI

Int Conf AIDS. 2006 Aug 13-18;16 Abstract No. MoAb0405

Chinkhumba J.¹, Fergusson P.², Thurstans S.³, Nyirenda G.¹, Mafupa H.¹, Tomkins A.^4
1Action Against Hunger, HIV research, Lilongwe, Malawi, ²Action Against Hunger, University of Chester, HIV and nutrition, Chester, United Kingdom, ³Action Against Hunger, HIV and nutrition, Lilongwe, Malawi, ⁴Institute of Child Health, London, United Kingdom

BACKGROUND: The objective of the study was to ascertain the impact HIV status has on death patterns in severely malnourished children admitted for therapeutic feeding in Nutrition Rehabilitation Units (NRUs).

METHODS: A nested study auditing deaths in a cohort of 295 severely malnourished children recruited over a ten month period. Upon admission, all severely malnourished children were treated with F75/F100. Routine medical care including systematic antibiotics and anti- malarials was provided. Upon discharge, the children received supplementary rations for 16 weeks.

RESULTS: Overall mortality was 15.9% (47/295). Mean age on admission was 22 months (range 7-52), Average number of days from admission to death was 19 days (range 0-170). HIV positive children had a mean admission of 20 days (SD39.6) compared with 11.7 days (SD22) for HIV negative children. Overall HIV prevalence was 17%. 50% of children who died were HIV positive: 65% male and 38% female. 67% of HIV positive children were marasmic compared to 33% in HIV negative children (P<0.05). 47% of HIV positive children had Kwashiorkor compared to 53 % of HIV negative children (P >0.05). 67% of the HIV positive children died in phase 1 compared to 33% HIV negative (P<0.05). No marked differences existed among transitional and phase two nor was there a significant difference as to whether a child died in the hospital or home.

CONCLUSIONS: HIV positive severely malnourished children have a greater risk of dying in early rehabilitation and the average admission in the NRU is nearly twice as long in HIV positive children than HIV negative. There is need for prompt referral of malnourished children to NRUs and need for early identification of HIV status in children and caretakers for essential access to HIV treatment. More effective treatment regimes for HIV positive children in early rehabilitation need to be developed and tested.

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2006-08-13
MoAb0405

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