THPE070 - Poster Exhibition
Long term outcomes of HIV-infected Malawian infants started on antiretroviral therapy while hospitalized
A. Bhalakia1, M. Bvumbwe2, G.A. Preidis3, P.N. Kazembe2, N. Esteban-Cruciani1, M.C. Hosseinipour4, E.D. Mccollum4,5
1Albert Einstein College of Medicine and Children's Hospital at Montefiore, Pediatrics, Bronx, United States, 2Baylor College of Medicine Abbott-Fund Children's Clinical Centre of Excellence, Lilongwe, Malawi, 3Baylor College of Medicine, Pediatrics, Houston, United States, 4University of North Carolina Project, Lilongwe, Malawi, 5Johns Hopkins School of Medicine, Pediatrics, Division of Pulmonology, Baltimore, United States
Background: The majority of HIV-infected infants in Malawi are diagnosed using DNA PCR and wait 6 or more weeks for the test results, potentially delaying ART initiation. While inpatient initiation of ART can reduce the time to ART in this highly vulnerable group of patients, the long-term outcomes of inpatient ART initiation in HIV-infected African infants is not widely reported. The objective of this study was to analyze long-term outcomes and characteristics of a cohort of HIV-infected infants who were diagnosed with HIV and initiated on ART in the hospital setting.
Methods: We determined long-term outcomes of HIV-infected infants diagnosed with HIV and started on ART while hospitalized in Lilongwe, Malawi. We also interviewed caregivers using a standard questionnaire about the characteristics of their children. The interviews were conducted between July 2012 and April 2013. The data was analyzed using Pearson''s chi-square and Fisher exact tests.
Results: Outcomes of the 74 study participants discharged from the hospital alive were determined at a median duration of 11.6 months after enrollment into the study. Forty-five patients (60.8%) remained alive and in care, 16 (21.6%) had died, 12 (16.2%) were lost-to-follow-up, and one (1.4%) was alive but refused care. Of the 16 children who died, median time from ART initiation to death was 2.7 months. Causes of death include pneumonia, diarrhea, fever, anemia, malnutrition, malaria and tuberculosis. Ten (62.5%) were on ART at the time of death, 4 (25%) were not on ART, and 2 (12.5%) were unknown. Forty (54.1%) patients'' guardians were interviewed about characteristics of their children on ART. Five reported defaulting off of ART after initiation, for reasons that include missed appointments and unpleasant ART side effects. Four (80%) of the 5 patients re-started ART within a median time of 3.4 months; 1 patient died before re-starting ART.
Conclusions: One-year retention rates of HIV-infected infants diagnosed and started on ART in the hospital setting are comparable to outpatient ART initiations in other Sub-Saharan countries. Further studies are needed to determine if inpatient diagnosis and ART initiation can provide additional benefit to this population?a subset of patients with otherwise extremely high mortality rates.
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