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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Markers for predicting mortality in untreated HIV-infected children in resource-limited settings: A meta-analysis
AIDS, Volume 22, No. 1, Year 2008
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Description
OBJECTIVES: To evaluate the prognostic value of selected laboratory and growth markers on the short-term risk of mortality in untreated HIV-infected children in resource-limited settings. DESIGN: A meta-analysis of individual longitudinal data on children aged 12 months onwards from 10 studies (nine African, one Brazilian in the 3Cs4kids collaboration). METHODS: The risk of death within 12 months based on age and the most recent measurements of laboratory and growth markers was estimated using Poisson regression models, adjusted for cotrimoxazole prophylaxis use and study effects. RESULTS: A total of 2510 children contributed 357 deaths during 3769 child-years-at-risk, with 81% follow-up occurring after start of cotrimoxazole. At first measurement, median age was 4.0 years (interquartile range, 2.2-7.0 years), median CD4% was 15% and weight-for-age z-score -1.9. CD4% and CD4 cell count were the strongest predictors of mortality, followed by weight-for-age and haemoglobin. After adjusting for these markers, the effects of total lymphocyte count and BMI-for-age were relatively small. Young children who were both severely malnourished and anaemic had high mortality regardless of CD4 values, particularly those aged 1-2 years. By contrast, high CD4% or CD4 cell count values predicted low mortality level amongst either children older than 5 years or those younger with neither severe malnutrition nor anaemia. CONCLUSIONS: CD4 measurements are the most important indicator of mortality and wider access to affordable tests is needed in resource-limited settings. Evaluation of antiretroviral initiation in children also needs to consider weight-for-age and haemoglobin. Prevention and treatment of malnutrition and anaemia is integral to HIV paediatric care and could improve survival. © 2008 Lippincott Williams & Wilkins, Inc.
Authors & Co-Authors
Duong, Trin
Unknown Affiliation
Gibb, Diana M.
Unknown Affiliation
Dunn, David T.
Unknown Affiliation
Chintu, Chifumbe Z.
Unknown Affiliation
Mulenga, Veronica
Unknown Affiliation
Cotton, Mark Fredric
Unknown Affiliation
Eley, Brian S.
Unknown Affiliation
Zar, Heather J.
Unknown Affiliation
Ellis, Jane C.
Unknown Affiliation
Graham, Stephen Michael
Unknown Affiliation
Giaquinto, Carlo
Unknown Affiliation
Nanyonga, Maria
Unknown Affiliation
Msellati, Philippe
Unknown Affiliation
Meyers, Tammy M.M.
Unknown Affiliation
Moultrie, Harry
Unknown Affiliation
Hani, Chris
Unknown Affiliation
Pinto, Jorge Andrade
Unknown Affiliation
Roux, Paul
Unknown Affiliation
Weigel, Ralf
Unknown Affiliation
Kankasa, Chipepo
Unknown Affiliation
Fassinou, Patricia
Unknown Affiliation
Elenga, Narcisse
Unknown Affiliation
Morelli, Erika
Unknown Affiliation
Atai, Betty
Unknown Affiliation
Araújo, Claudete
Unknown Affiliation
Carvalho, Andrea
Unknown Affiliation
Carvalho, Inácio
Unknown Affiliation
Diniz, Ana
Unknown Affiliation
Ferreira, Flávia Gomes Faleiro
Unknown Affiliation
Lobato, Vanessa
Unknown Affiliation
Sanchez, Talitah
Unknown Affiliation
Duong, Trinh
Unknown Affiliation
Duff, Charlotte
Unknown Affiliation
Statistics
Citations: 88
Authors: 33
Affiliations: 14
Identifiers
Doi:
10.1097/01.aids.0000302262.51286.a5
Research Areas
Food Security
Health System And Policy
Infectious Diseases
Maternal And Child Health
Study Design
Cohort Study
Study Approach
Systematic review