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J Int Assoc Provid AIDS Care. 2015 Mar-Apr;14(2):172-9. doi: 10.1177/2325957413500852. Epub 2013 Oct 8.

Nutritional Status and Other Baseline Predictors of Mortality among HIV-Infected Children Initiating Antiretroviral Therapy in Tanzania.

Author information

1
Department of Nutrition, Harvard School of Public Health, Boston, MA, USA Management and Development for Health (MDH), Dar es Salaam, Tanzania rastemwi@mail.harvard.edu.
2
Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.
3
Department of Nutrition, Harvard School of Public Health, Boston, MA, USA Division of GI/Nutrition, Center for Nutrition, Boston Children's Hospital, Boston, MA, USA.
4
Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.
5
Ministry of Health and Social Welfare, Dar es Salaam, Tanzania.
6
Department of Nutrition, Harvard School of Public Health, Boston, MA, USA Management and Development for Health (MDH), Dar es Salaam, Tanzania.
7
Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
8
Department of Nutrition, Harvard School of Public Health, Boston, MA, USA Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA.

Abstract

BACKGROUND:

We assembled a prospective cohort of 3144 children less than 15 years of age initiating antiretroviral therapy (ART) in Dar es Salaam, Tanzania.

METHODS:

The relationships of nutritional status and other baseline characteristics in relation to mortality were examined using Cox proportional hazards model.

RESULTS:

Compared with children with weight for age (WAZ) > -1, those with WAZ ≤ -2 to < -3 had a nearly double risk of death (relative risk [RR], 1.85; 95% confidence interval [CI], 1.10-3.11), and among those with WAZ ≤ -3, the risk more than tripled (RR, 3.36; 95% CI, 2.12-5.32). Other baseline risk factors for overall mortality included severe anemia (P < .001), severe immune suppression (P = .02), history of tuberculosis (P = .01), opportunistic infections (P < .001), living in the poorest district (P < .001), and advanced World Health Organization stage (P = .003).

CONCLUSIONS:

To sustain the obtained benefit of ART in this setting, interventions to improve nutritional status may be used as an adjunct to ART.

KEYWORDS:

AIDS; HIV; Tanzania; children; mortality

PMID:
24106055
PMCID:
PMC4627587
DOI:
10.1177/2325957413500852
[Indexed for MEDLINE]
Free PMC Article
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