Risk factors of immune suppression, viral suppression failure and mortality of HIV-Infected children and adolescents

Abstract

Background: To achieve ending AIDs beyond 2030 as UNESCO policy, we studied risk factors of pediatric HIV infection morbidity and mortality at Nakhonpathom Hospital, Thailand. We expected that there is useful information for the development of health service
to improve outcome of pediatric HIV infection care.
Objective: To study risk factors of the failure in restoration of immunity, viral suppression and mortality of HIV-infected children and adolescents.
Method: A retrospective cohort study of HIV-infected children and adolescence (0-20 yearsold) during April 2001 - March 2020 (19 years). Demographic, clinical and laboratory data were collected. Risk factors were analyzed by chi-square and multivariate logistic regression with odds ratio at 95% confidence interval and p-value < 0.005 as statistical significance.
Result: Total 150 patients tested for CD4 were included. Females were 58.7%. The baseline age of antiretroviral therapy (ART) at 5 - 15 years old were 65.7%. The majority (92.6%) received non-PI based regimen and 61% continued same regimen. Weight and height 50 percentiles (PT) increased after antiretroviral therapy (ART) from 25.2% and 24.5% to 42.5% and 43.2%, respectively. The CD4 20% increased after ART from 26.5% to 66.7% and 53.8% had viral suppression (VL < 20 copies/cu.mm.). The majority (87.3%) were alive,
mortality rate was 12.7% and rate of loss to follow up was 12%. Statistical significance risk factors of immune suppression (last CD4 < 20%) were last height < 3rd PT odds ratio = 19.8, poor drug adherence odds ratio = 11.7, last weight < 3rd PT odds ratio = 4.2, baseline height < 3rd PT odds ratio = 2.35, last viral load ≥ 20 copies/cu.mm. odds ratio = 2.1 and delayed ART at > 5 - 15 years old odds ratio = 1.6. Statistical significance risk factors of the failure of viral load suppression (last VL ≥ 20 copies/cu.mm.) were mortality odds ratio = 11.4, first line drug resistance odds ratio = 4.98, poor adherence odds ratio = 3.37, delayed ART at > 5 - 15 years old odds ratio = 2.62 last height < 3rd PT and last CD4 < 20%: same odds ratio = 2.11 and baseline weight < 3rd PT odds ratio = 1.6. Statistic significance risk factors of mortality were delayed ART at > 5 - 15 years old odds ratio = 3.1, poor adherence odds ratio was too high to calculation, low last CD4 level (CD4 < 20%) odds ratio was too high to calculation, last VL ≥ 20 copies/cu.mm. odds ratio = 2.43, baseline weight and height < 3rd PT odds ratio = 13.62, 7.34, respectively and last weight and height < 3rd PT odds ratio
= 20.52, 20.23, respectively.
Conclusion: The risk factors of immune suppression, viral suppression failure and mortality in HIV-infected child and adolescents were poor drug adherence, delayed antiretroviral therapy, low precursor CD4 and failure to thrive.