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

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.