Growth, morbidity, and mortality in a cohort of institutionalized HIV-1-infected African children.

Journal article

OBJECTIVE: As a result of the HIV epidemic in Africa, much debate exists on whether institutionalized compared with community-based care provides optimum management of infected children. Previous reports calculated 89% mortality by age 3 years among outpatients in Malawi. No similar data are available for infected children in institutionalized care. We characterized patterns of morbidity and mortality among HIV-1-infected children residing at an orphanage in Nairobi. METHODS: Medical records for 174 children followed over 5 years were reviewed. Mortality was analyzed by Kaplan-Meier methods with adjustment to account for survival in the community before admission. Anthropometric indices were calculated to include mean z scores for weight for length and length for age. Low indices reflected wasting and stunting. Opportunistic infections were documented. RESULTS: Of 174 children, 64 had died. Survival was 70% at age 3 years. Morbidity included recurrent respiratory tract infections, gastroenteritis, parotitis, and lymphoid interstitial pneumonitis. No new cases of tuberculosis disease were noted after admission. Mean z scores for length for age suggested overall stunting (z = -1.65). Wasting was not observed (z = -0.39). CONCLUSION: The optimal form of care for HIV-infected children in resource-poor settings may be the development of similar homes. Absence of tuberculosis disease in long-standing residents may have contributed to improved survival. Stunting in the absence of wasting implied that growth was compromised by opportunistic infections and other cofactors.

Authors: Nathan, L; Nerlander, L; Dixon, JR; Ripley, R; Barnabas, R

• Publication status: Published
• Journal: Journal of acquired immune deficiency syndromes (1999)
• Volume: 34
• Issue: 2
• Pages: 237-241
• Publication date: 2003-10-01
• DOI: 10.1097/00126334-200310010-00015
• EISSN: 1944-7884
• ISSN: 1525-4135
• Language: English
• Keywords: Infant; Humans; Child, Institutionalized; HIV-1; Child; Adolescent; Cohort Studies; Child, Preschool; Acquired Immunodeficiency Syndrome; Morbidity; Retrospective Studies; Growth; Kenya