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Mortality and associated factors after initiation of pediatric antiretroviral treatment in the Democratic Republic of the Congo

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Abstract
Objective: We aimed to describe factors associated with mortality among children receiving antiretroviral treatment (ART) at a pediatric hospital in Kinshasa, Democratic Republic of the Congo. Results: Two hundred ninety-nine children, < 18 years old, were followed for a median of 77 weeks (interquartile range: 61-103) post-ART initiation. Survival probability was 89.6% [95% confidence interval (CI): 85.5-92,6%] at 12 months; 24 of 31 deaths (77.4%) Occurred within 2 months of ART initiation. Predictors of mortality in bivariate analysis were 2 opportunistic infections before ART initiation, severe immunosuppression as defined by age-specific CD4 count or percentage criteria, hemoglobin < 9 g/dL, oral candidiasis, and severe malnutrition. In multivariate analysis, weight for age z-score [hazard ratio (HR): 0.39; 95% CI: 0.27-0.61; P < 0.001] and oral candidiasis (HR: 5.86; 95% CI: 2.34-14.65; P = 0.0002) were independent predictors of mortality. Suspected septic shock was file most common cause of death (n = 12/31, 38.7%). Conclusions: Children receiving ART in this resource-poor setting were at the highest risk of dying in the first 2 months of ART, particularly when they presented with malnutrition or oral candidiasis. Optimal timing of ART initiation during nutritional rehabilitation should be determined. Promotion of early care seeking, strengthened health care, and prevention services are important to further improve outcome of pediatric ART in resource-poor settings.
Keywords
MALNUTRITION, HIV/AIDS, THERAPY, INCOME COUNTRIES, ZAMBIAN CHILDREN, AFRICAN CHILDREN, HIV-1-INFECTED CHILDREN, HIV-INFECTED CHILDREN, SEVERELY MALNOURISHED CHILDREN, RESOURCE-LIMITED SETTINGS, malnutrition, mortality, survival, HIV, Democratic Republic of the Congo, sub-Saharan Africa, child, antiretroviral treatment

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MLA
Callens, Steven, Nicole Shabani, Jean Lusiama, et al. “Mortality and Associated Factors After Initiation of Pediatric Antiretroviral Treatment in the Democratic Republic of the Congo.” PEDIATRIC INFECTIOUS DISEASE JOURNAL 28.1 (2009): 35–40. Print.
APA
Callens, S., Shabani, N., Lusiama, J., Lelo, P., Kitetele, F., Colebunders, R., Gizlice, Z., et al. (2009). Mortality and associated factors after initiation of pediatric antiretroviral treatment in the Democratic Republic of the Congo. PEDIATRIC INFECTIOUS DISEASE JOURNAL, 28(1), 35–40.
Chicago author-date
Callens, Steven, Nicole Shabani, Jean Lusiama, Patricia Lelo, Faustin Kitetele, Robert Colebunders, Ziya Gizlice, Andrew Edmonds, Annelies Van Rie, and Frieda Behets. 2009. “Mortality and Associated Factors After Initiation of Pediatric Antiretroviral Treatment in the Democratic Republic of the Congo.” Pediatric Infectious Disease Journal 28 (1): 35–40.
Chicago author-date (all authors)
Callens, Steven, Nicole Shabani, Jean Lusiama, Patricia Lelo, Faustin Kitetele, Robert Colebunders, Ziya Gizlice, Andrew Edmonds, Annelies Van Rie, and Frieda Behets. 2009. “Mortality and Associated Factors After Initiation of Pediatric Antiretroviral Treatment in the Democratic Republic of the Congo.” Pediatric Infectious Disease Journal 28 (1): 35–40.
Vancouver
1.
Callens S, Shabani N, Lusiama J, Lelo P, Kitetele F, Colebunders R, et al. Mortality and associated factors after initiation of pediatric antiretroviral treatment in the Democratic Republic of the Congo. PEDIATRIC INFECTIOUS DISEASE JOURNAL. 2009;28(1):35–40.
IEEE
[1]
S. Callens et al., “Mortality and associated factors after initiation of pediatric antiretroviral treatment in the Democratic Republic of the Congo,” PEDIATRIC INFECTIOUS DISEASE JOURNAL, vol. 28, no. 1, pp. 35–40, 2009.
@article{2308740,
  abstract     = {Objective: We aimed to describe factors associated with mortality among children receiving antiretroviral treatment (ART) at a pediatric hospital in Kinshasa, Democratic Republic of the Congo. 
Results: Two hundred ninety-nine children, < 18 years old, were followed for a median of 77 weeks (interquartile range: 61-103) post-ART initiation. Survival probability was 89.6% [95% confidence interval (CI): 85.5-92,6%] at 12 months; 24 of 31 deaths (77.4%) Occurred within 2 months of ART initiation. Predictors of mortality in bivariate analysis were 2 opportunistic infections before ART initiation, severe immunosuppression as defined by age-specific CD4 count or percentage criteria, hemoglobin < 9 g/dL, oral candidiasis, and severe malnutrition. In multivariate analysis, weight for age z-score [hazard ratio (HR): 0.39; 95% CI: 0.27-0.61; P < 0.001] and oral candidiasis (HR: 5.86; 95% CI: 2.34-14.65; P = 0.0002) were independent predictors of mortality. Suspected septic shock was file most common cause of death (n = 12/31, 38.7%). 
Conclusions: Children receiving ART in this resource-poor setting were at the highest risk of dying in the first 2 months of ART, particularly when they presented with malnutrition or oral candidiasis. Optimal timing of ART initiation during nutritional rehabilitation should be determined. Promotion of early care seeking, strengthened health care, and prevention services are important to further improve outcome of pediatric ART in resource-poor settings.},
  author       = {Callens, Steven and Shabani, Nicole and Lusiama, Jean and Lelo, Patricia and Kitetele, Faustin and Colebunders, Robert and Gizlice, Ziya and Edmonds, Andrew and Van Rie, Annelies and Behets, Frieda},
  issn         = {0891-3668},
  journal      = {PEDIATRIC INFECTIOUS DISEASE JOURNAL},
  keywords     = {MALNUTRITION,HIV/AIDS,THERAPY,INCOME COUNTRIES,ZAMBIAN CHILDREN,AFRICAN CHILDREN,HIV-1-INFECTED CHILDREN,HIV-INFECTED CHILDREN,SEVERELY MALNOURISHED CHILDREN,RESOURCE-LIMITED SETTINGS,malnutrition,mortality,survival,HIV,Democratic Republic of the Congo,sub-Saharan Africa,child,antiretroviral treatment},
  language     = {eng},
  number       = {1},
  pages        = {35--40},
  title        = {Mortality and associated factors after initiation of pediatric antiretroviral treatment in the Democratic Republic of the Congo},
  url          = {http://dx.doi.org/10.1097/INF.0b013e318184eeb9},
  volume       = {28},
  year         = {2009},
}

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