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Morbidity and Mortality of a Large Cohort of Peruvian HIV-infected Children, 2003-2012

Session: Oral Abstract Session: Global Infectious Diseases
Saturday, October 11, 2014: 3:15 PM
Room: The Pennsylvania Convention Center: 111-AB
Background: Data on pediatric HIV in Peru is limited.  The National Institute of Child Health (Instituto Nacional de Salud del Niño: INSN) cares for the largest number of HIV-infected children under age 18 in the country.  We describe the morbidity and mortality of children seen at INSN’s HIV clinic over the 10 years when highly active antiretroviral therapy (HAART) and prevention of mother-to-child transmission (pMTCT) interventions were available. 

Methods: We conducted a retrospective chart review of INSN HIV clinic patients between 2003−2012. De-identified data was collected and analyzed: date of birth, sex, place of residence, HIV transmission mode, age and CDC clinical stage at diagnosis (1994 guidelines), number of hospitalizations and diagnoses, and mortality.

Results: A total of 288 children were included: 50% (145/288) were male; 80% (231/288) lived in metropolitan Lima and 20% (57/288) in Peru’s provinces.  Perinatal transmission was the mode of HIV infection in 93% (250/270). Only 17% (32/191) of mothers were known to be HIV infected at delivery; of these mothers, 40% (13/32) were on antiretroviral therapy at delivery, 72% (23/32) had a Cesarean section, and 47% (15/32) of their infants received antiretroviral prophylaxis.  At child HIV diagnosis, median age was 32.7 months (IQR 14.8-76.3 months), and 67% (143/213) had advanced disease (CDC clinical stage C). One-third (36%, 68/191) had been hospitalized prior to being diagnosed, most once (51%, 35/68) or 2-3 times (37%, 25/68).  There were 567 hospitalizations among 209 patients.  The most frequent diagnoses were bacterial pneumonia (n=147), chronic malnutrition (n=104), diarrhea (n=80), anemia (n=76), and Mycobacterium tuberculosis (n=34).  Twenty-five patients (9%) are known to have died, at a mean age of 71.4 months (range 9-188 months).

Conclusion: Most cases were acquired via perinatal transmission, few mothers were diagnosed before delivery, and among mothers with known HIV status, pMTCT was suboptimal. Most children were diagnosed with advanced disease and a significant minority had been hospitalized prior to diagnosis.  These findings have important implications for improving both early pediatric HIV diagnosis and treatment and pMTCT strategies.

Amira Baker, MD1, Angela Bayer, PhD2, Jaime Deville, MD1, Rolando Viani, MD3 and Lenka Kolevic, MD4, (1)Pediatrics, University of California, Los Angeles, Los Angeles, CA, (2)Medicine, University of California, Los Angeles, Los Angeles, CA, (3)Pediatrics, University of California, San Diego, La Jolla, CA, (4)Pediatrics, Instituto Nacional de Salud del Niņo, Lima, Peru


A. Baker, None

A. Bayer, None

J. Deville, None

R. Viani, None

L. Kolevic, None

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