Ebissa Getachew, Deyessa Negusse, Biadgilign Sibhatu
a Department of General Public Health, College of Health Sciences , Haramaya University , Harar , Ethiopia.
AIDS Care. 2015;27(6):723-30. doi: 10.1080/09540121.2014.997180. Epub 2015 Jan 19.
Highly active antiretroviral therapy (HAART) is the breakthrough in care and treatment of people living with HIV, leading to a reduction in mortality and an improvement in the quality of life. Without antiretroviral treatment, most HIV-infected children die before their fifth birthday. So the objective of this study is to determine the mortality and associated factors in a cohort of HIV-infected children receiving ART in Ethiopia. A multicentre facility-based retrospective cohort study was done in selected pediatric ART units in hospitals found in Addis Ababa, Ethiopia. The probability of survival was estimated using the Kaplan-Meier method, and multivariate analysis by Cox proportional hazards regression models was conducted to determine the independent predictor of survival. A total of 556 children were included in this study. Of the total children, 10.4% were died in the overall cohort. More deaths (70%) occurred in the first 6 months of ART initiation, and the remaining others were still on follow-up at different hospitals. Underweight (moderate and severe; HR: 10.10; 95% CI: 2.08, 28.00; P = 0.004; and HR: 46.69; 95% CI: 9.26, 200.45; P < 0.01, respectively), advanced disease stage (WHO clinical stages III and IV; HR: 10.13: 95% CI: 2.25, 45.58; P = 0.003), poor ART adherence (HR: 11.72; 95% CI: 1.60, 48.44; P = 0.015), and hemoglobin level less than 7 g/dl (HR: 4.08: 95% CI: 1.33, 12.56; P = 0.014) were confirmed as significant independent predictors of death after controlling for other factors. Underweight, advanced disease stage, poor adherence to ART, and anemia appear to be independent predictor of survival in HIV-infected children receiving HAART at the pediatric units of public hospitals in Ethiopia. Nutritional supplementations, early initiation of HAART, close supervision, and monitoring of patients during the first 6 months, the follow up period is recommended.
高效抗逆转录病毒疗法（HAART）是艾滋病毒感染者护理和治疗方面的一项突破，可降低死亡率并改善生活质量。如果不进行抗逆转录病毒治疗，大多数感染艾滋病毒的儿童会在五岁前死亡。因此，本研究的目的是确定埃塞俄比亚接受抗逆转录病毒治疗的一组艾滋病毒感染儿童的死亡率及相关因素。在埃塞俄比亚亚的斯亚贝巴的选定医院儿科抗逆转录病毒治疗单位开展了一项基于多中心机构的回顾性队列研究。使用Kaplan-Meier方法估计生存概率，并通过Cox比例风险回归模型进行多变量分析，以确定生存的独立预测因素。本研究共纳入556名儿童。在整个队列中，10.4%的儿童死亡。更多死亡（70%）发生在开始抗逆转录病毒治疗的前6个月，其余儿童仍在不同医院接受随访。在控制其他因素后，体重不足（中度和重度；风险比：10.10；95%置信区间：2.08，28.00；P = 0.004；风险比：46.69；95%置信区间：9.26，200.45；P < 0.01）、疾病晚期（世界卫生组织临床分期III和IV期；风险比：10.13：95%置信区间：2.25，45.58；P = 0.003）、抗逆转录病毒治疗依从性差（风险比：11.72；95%置信区间：1.60，48.44；P = 0.015）以及血红蛋白水平低于7 g/dl（风险比：4.08：95%置信区间：1.33，12.56；P = 0.014）被确认为死亡的重要独立预测因素。在埃塞俄比亚公立医院儿科单位接受HAART的艾滋病毒感染儿童中，体重不足、疾病晚期、抗逆转录病毒治疗依从性差和贫血似乎是生存的独立预测因素。建议进行营养补充、尽早开始HAART、在前6个月密切监督和监测患者以及进行随访。
