Predictors of survival at three years follow up for HIV-infected children in Cote D’Ivoire
Polly Clayden, HIV i-Base
In an oral presentation from the ANRS 1244/1278 study Dr Philippe Msellati of the Institute de Recherche pour le Development, Montpelier, France reported predictors of survival in children enrolled in the study at three years. This observational cohort enrolled children between October 2000 and December 2003 and followed them until the end of September 2004.
The investigators evaluated multiple factors that could influence a childs survival: whether the parents were alive; age and sex; route of infection; history of TB, malnutrition and of HAART before recruitment and anthropometric measures. Additionally, they analysed hepatitis B, haemoglobin, platelets, number of total lymphocytes, CD4 counts and percentage, and viral load. Probabilities of survival were estimated using the Kaplan-Meier method. Cox proportional hazards regression models were used.
Two hundred and eighty two children were enrolled (129 girls and 153 boys) with a mean age of 5.8 years. The majority of children (98%) had been infected through mother to child transmission. The median baseline CD4% was 14% and the median viral load was 160,000 copies/mL. The average follow up was 2.17 years.
After one year of follow up 85.5% children had survived and 80.9% were still alive at 3 years of follow up.
The investigators reported low weight for age (Z score <-3), history of tuberculosis and viral load >5 log copies/ml had a negative effect on survival (RR: 5.86, 2.37 and 2.04 respectively). They also found that CD4>15% and initiation of HAART before observation or during the first six months of follow up had a protective effect (RR 0.49 and 0.29 respectively). In a model without viral load age over 2 years and CD4>15% were protective (RR: 0.46 and 0.45 respectively).
Msellati P, Anaky MF, Rouet F et al. Clinical and biological factors at recruitment in HIV-infected children in relation with three years survival in Abidjan, Cote DIvoire; the experience of the ANRS 1244/1278 study. 3rd IAS Conference on HIV Pathogenesis and Treatment, Rio de Janeiro, 2005. Abstract WeOa0101.