Survival and Factors Influencing Treatment Outcomes of HIV Infected Children Below 15 Years on First-Line HAART at Mbale Hospital.

Abstract

Background: The Mbale regional referral hospital HIV care ART annual report for the year ending 31/12/2011 indicated that over 12% (49/401) of the children below 15 years that were on HAART were on second-line HAART and another 2% on first-line HAART had virologic failure and awaited switch to second-line HAART. Evidence from other settings in Uganda has shown more successful survival outcomes among children on first-line HAART but in Mbale hospital the outcomes are less successful. Objective: To determine the survival and factors influencing the treatment outcomes of HIV-infected children under 15 years on first-line HAART at Mbale Hospital Methods: A retrospective cohort design was used and records of 340 HIV-infected children under 15 years on first-line HAART at Mbale Hospital were abstracted. Analysis was based on the Kaplan Meier technique. Survivor function and hazard functions where two-sided log rank test for equality of survival functions and test for trend were done. The extended Cox proportional hazards model was used and covariates adjusted for. Results: The overall survival was estimated to be 68.5%, CI= (52.8-79.9). The survival estimates at months; 12, 24 and 36 was; 100%, 95.8% (CI= 92.5-97.6) and 90.3% (CI= 85.4-93.7) respectively. After controlling for other factors, the factors influencing switch to second line HAART among HIV-infected children less than 15 years on first-line HAART were sex and baseline CD4 count. Conclusions: The findings show that HIV-infected children on first-line HAART at Mbale Hospital have an overall survival that is lower compared to other settings. Being female and having a CD4 count greater than 200 cells/ul at initiation of first-line HAART increases survival. In HIV-infected children less than 15 years initiation on nevirapine-based first-line HAART is non inferior to initiation on efaverenz-based first-line HAART.

Recommendations: The communities should be sensitized to bring HIV-infected children early to the ART clinic so that they can be monitored and started on first-line HAART at CD4 counts above 200 cells/ul in order to improve these children’s overall survival on first-line HAART. Male HIV-infected children should be monitored more closely before and after initiation of first-line HAART in order to improve their survival. The influence of baseline viral loads on survival of HIV-infected children on first-line HAART was not assessed in this study and would be an area for further research since studies in other settings have shown that high baseline viral loads are associated with increased chances of switching to second-line HAART.