Most deaths among children enrolled in two program settings in Cambodia occur within the first 6 months after enrolment. Early mortality rates were more than nine-fold higher among children not yet initiated on ART compared to those placed on treatment. Urgent measures to promptly initiate ART in eligible children should be taken such as a fast-track procedure, earlier preparatory counselling sessions, improved access to laboratory tests and results, systematic HIV screening in children diagnosed with TB and considering early ART initiation among children treated for TB.

•National HIV prevalence rate 0.9% (2006)• 2 programs: pediatric HIV clinic of Takeo public hospital and the HIV clinic of the charity-run ‘Angkor Hospital for Children’ in Siem Reap• Care and ART (3TC/D4T/NVP or EFV)delivered free of charge

There is very limited documented information on the importance of early mortality (death within first 6 months) among children enrolled within HIV/AIDS programs in resource-limited settings.

• Retrospective cohort study using patient data entered in HIV-specific software

• All children admitted from 2002 until end 2007 included. Observation period ended in April 2008

• Cox-regression analysis done to assess for risk factors of early death

• Likely cause of death assessed from patient chart review

Early mortality (pre and post antiretroviral treatment) amongst children with HIV/AIDS enrolled

in two programs in CambodiaRaguenaud ME.¹, Isaakidis P.¹, Vantha T.², Seithaboth S.³, Kazumi A.³, Zachariah

R4

¹ Médecins Sans Frontières (MSF), Cambodia, ² Donkeo Referral Hospital, Ministry of Health, Takeo, Cambodia, ³ Angkor Hospital for Children, Siem Reap, Cambodia, 4 Médecins Sans

Frontières, Operational Centre Brussels

• Total of 1246 children enrolled in HIV program (48% girls)

• 146 (12%) were <18 months, 564 (45%) 18-60months, and 536 (43%)>60months

• Median CD4% 17.9 (10.0-24.2) in 18-60 months age

• Median CD4 218cells/mm³(39-562) in >=5yrs age

•714 (57%) started ARV treatment

• Median ART initiation time: 4.8 months (IQR:2.8-9.1)

• Median time from ART eligibility until ART start: 3.6 months (IQR:2.2-7.1)

Conclusions

Poster THPE0101 XVII International AIDS Conference

BACKGROUND

We a) determined the incidence of early mortality prior to and after initiating ART and b) assessed risk factors associated with early mortality.

OBJECTIVES

SETTING

METHODS

RESULTS

Among all patients (from screening)

Person-time on ART (from start of treatment)

Person-time not on ART (from screening)

Time period

Deaths (% of total deaths)

Person-years

Rate per 100 PY

Deaths (% of total deaths)

Person-years

Rate per 100 PY

Deaths (% of total deaths)

Person-years

Rate per 100 PY

Up to 90 days

39 (36%)

2537 1.5

2 (1.8%)

1443 0.1

37 (34%)

657 5.6

Up to 180 days

62 (57%)

2537 2.4

12 (11%)

1443 0.8

50 (46%)

657 7.6

Until end of observation period

109 (100%)

2537 4.3

39 (36%)

1443 2.7

70 (64%)

657 10.6

Table. Cumulative death rates by 3 and 6 months of HIV-positive children in the Donkeo hospital and AHC.

Enrolment and follow up

Death rates

Risk factors for early mortality

Cause of early death

Status at end of study Children on ART Children not on ART In active cohort 601 (84%) 293 (55%) Loss to follow-up 13 (2%) 129 (24%) Dead 39 (5%) 70 (13%) Transferred out 61 (9%) 40 (8%)

• 41 out of 50 (82%) children with early death before treatment met the ART eligibility criteria.

• Median delay between ART eligibility date and date of death: 50 days (IQR: 24-74)

50 of 62 (82%) children who died within 6 months of enrolment in the HIV programs were not yet receiving ART

Early mortality rate was 9.5 times higher in patients not treated than in patients on ART

• In the univariate analysis, among children not on treatment, early death was associated with male sex, CDC stage C, baseline CD4 <200, CD4%<15%, admission during the early years of the program (before 2006), and W/H <-2 z-score.

• In the multivariate analysis only blood CD4 was associated with early death:

- Mortality rate ratio comparing those with CD4 cell counts <200 and ≥200 cells/mm³ was 8.10 (95%CI, 1.1-61.4)

- Mortality rate ratio comparing those with CD4 % <15% and ≥15% was 11.1 (95%CI, 1.0-119.0)

Cause of death All patients (n=62) Patients receivingART (n=12)

Patients not receiving ART (n=50)

Tuberculosis 28 (45.2) 6 (50.0) 22 (44.0) Lower respiratory tract infection

16 (25.8) 3 (25.0) 13 (26.0)

Wasting syndrome 7 (11.3) 2 (16.7) 5 (10.0) Other 7 (11.3) 1 (8.3) 6 (12.0) Unknown 4 (6.4) 4 (8.0)