HIV Morbidity and Mortality in the Pediatric Population of Côte d'Ivoire

Introduction: The aim of our study was to describe the morbidity and mortality patterns in HIV-positive pediatric patients followed at the unit in charge of Pediatric HIV, in the pediatrics department of Cocody University Teaching Hospital (CHU-Cocody). Method: This hospital-based retrospective study focused on 218 pediatric patients enrolled at the CHU-Cocody from November 28th 2005 until June 30th 2010. Outcomes of children with anti-retroviral therapy (group A) and children without (Group B) anti-retroviral therapy were described and compared. Antiretroviral Therapy (ART) - eligibility followed national guidelines thus withholding treatment for immune-competent children or those with contraindications to ARTs such as increased transaminases (>10x) or vital distress. Results: The average age of children in group A, was 66.11 months, they were symptomatic in 84.74% of cases, and presented with severe immunodeficiency in 54.74%. The children in group B were younger (mean age=49.14 months), mostly only mildly symptomatic (39.80%) and thus usually without severe immunodeficiency (64.29%). Nearly all children were infected with HIV-1 and receiving cotrimoxazole prophylaxis. There were 764 disease events that occurred during follow-up including 633 in group A and 131 in group B. Anemia (p=0.036) and pneumonia (p=0.011) were more frequent in group A. Hospitalizations were more common in group A children (124/190) than group B children (10/28, p=0.0027). In Group B, the mortality rate was very high (75%) (OR=16, 95% CI [5.79-45.90.], P<0.001) and concerned predominantly children under the age of 24 months (OR=0.08, 95% CI [0.01-0.47.], p=0.0017) and earlier (OR=0.21, 95% CI [0.03-1.25.], P=0.047). Conclusion: Much remains to be done in countries with limited resources to improve pediatric HIV- treatment and survival, especially among the very young, which are weakened by childhood diseases. The implementation of WHO recommendations by the government must become a priority, this in order to improve the survival of affected children.