Impact of HIV exposure without infection on hospital course and mortality among young children in sub-Saharan Africa: a multi-site cohort study
Abstract Background Although mortality risk associated with HIV is well described, HIV-exposed uninfected (HEU) young children are also at increased risk of hospitalization and death as compared to HIV-unexposed uninfected (HUU) children. The drivers of poor outcomes among HEU children remain unknow...
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2024-12-01
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| Online Access: | https://doi.org/10.1186/s12916-024-03790-5 |
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| author | Christopher Lwanga Peace Aber Kirkby D. Tickell Moses M. Ngari John Mukisa Michael Atuhairwe Lindsay Brown Ezekiel Mupere Isabel Potani Lubaba Shahrin Brooks Morgan Benson O. Singa Victoria Nankabirwa Richard K. Mugambe Zakaria Mukasa Judd L. Walson James A. Berkley Christina L. Lancioni |
| author_facet | Christopher Lwanga Peace Aber Kirkby D. Tickell Moses M. Ngari John Mukisa Michael Atuhairwe Lindsay Brown Ezekiel Mupere Isabel Potani Lubaba Shahrin Brooks Morgan Benson O. Singa Victoria Nankabirwa Richard K. Mugambe Zakaria Mukasa Judd L. Walson James A. Berkley Christina L. Lancioni |
| author_sort | Christopher Lwanga |
| collection | DOAJ |
| description | Abstract Background Although mortality risk associated with HIV is well described, HIV-exposed uninfected (HEU) young children are also at increased risk of hospitalization and death as compared to HIV-unexposed uninfected (HUU) children. The drivers of poor outcomes among HEU children remain unknown, limiting the development of interventions to support this vulnerable population. Methods We performed a secondary analysis of data from a large multi-country prospective cohort [Childhood Acute Illness and Nutrition (CHAIN) Network] study. Data from 5 sites in Uganda, Kenya, and Malawi were included. Hospitalized children aged 2–23 months were followed from an index admission for 6 months after discharge to determine acute and long-term outcomes. Using perinatal HIV exposure (HEU and HUU) as the primary exposure and adjusting for child, caregiver, and household characteristics, we compared inpatient and 30-day survival outcomes, nutritional status, hospital length of stay, illness severity, and utilization of inpatient resources. Results We included 1486 children: 217 HEU and 1269 HUU. HEU children had an increased risk of mortality both during hospitalization [adjusted OR 1.96, 95% CI (1.14–3.37)] and in the 30 days following hospital admission [adjusted hazard ratio 2.20, 95% CI (1.10–4.42)]. Wasting and stunting were more frequent in HEU than HUU children, with adjusted OR 1.41, 95% CI (1.03–1.95) and adjusted OR 1.91, 95% CI (1.34–2.70), respectively. HEU children were also more likely to have a prolonged hospital stay compared to HUU children [adjusted OR 1.58, 95% CI (1.08–2.29)], although admission diagnoses, illness severity at admission, and use of inpatient resources (supplemental oxygen, nasogastric tube, and second-line antibiotics) did not differ significantly between groups. Conclusions HEU children are more likely to die during hospitalization and within 30 days of admission, to be wasted and stunted upon hospital admission, and to require a prolonged hospital stay, as compared to HUU children. Hospitals in settings with a high prevalence of women-living-with-HIV should ensure that maternal HIV status is established among children requiring admission and build capacity to provide additional hospital monitoring and early post-discharge support for HEU children. |
| format | Article |
| id | doaj-art-1311d6c8c0fb4efb8c80bbe8d7a3c608 |
| institution | Kabale University |
| issn | 1741-7015 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | BMC |
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| series | BMC Medicine |
| spelling | doaj-art-1311d6c8c0fb4efb8c80bbe8d7a3c6082024-12-08T12:33:09ZengBMCBMC Medicine1741-70152024-12-0122111210.1186/s12916-024-03790-5Impact of HIV exposure without infection on hospital course and mortality among young children in sub-Saharan Africa: a multi-site cohort studyChristopher Lwanga0Peace Aber1Kirkby D. Tickell2Moses M. Ngari3John Mukisa4Michael Atuhairwe5Lindsay Brown6Ezekiel Mupere7Isabel Potani8Lubaba Shahrin9Brooks Morgan10Benson O. Singa11Victoria Nankabirwa12Richard K. Mugambe13Zakaria Mukasa14Judd L. Walson15James A. Berkley16Christina L. Lancioni17Uganda-Case Western Reserve University Research CollaborationUganda-Case Western Reserve University Research CollaborationThe Childhood Acute Illness and Nutrition (CHAIN) NetworkThe Childhood Acute Illness and Nutrition (CHAIN) NetworkUganda-Case Western Reserve University Research CollaborationUganda-Case Western Reserve University Research CollaborationSchool of Public Health, Oregon Health and Science UniversityUganda-Case Western Reserve University Research CollaborationThe Childhood Acute Illness and Nutrition (CHAIN) NetworkThe Childhood Acute Illness and Nutrition (CHAIN) NetworkDepartment of Global Health, University of WashingtonThe Childhood Acute Illness and Nutrition (CHAIN) NetworkSchool of Public Health, Makerere University College of Health SciencesSchool of Public Health, Makerere University College of Health SciencesMakerere University-Johns Hopkins University Research CollaborationThe Childhood Acute Illness and Nutrition (CHAIN) NetworkThe Childhood Acute Illness and Nutrition (CHAIN) NetworkThe Childhood Acute Illness and Nutrition (CHAIN) NetworkAbstract Background Although mortality risk associated with HIV is well described, HIV-exposed uninfected (HEU) young children are also at increased risk of hospitalization and death as compared to HIV-unexposed uninfected (HUU) children. The drivers of poor outcomes among HEU children remain unknown, limiting the development of interventions to support this vulnerable population. Methods We performed a secondary analysis of data from a large multi-country prospective cohort [Childhood Acute Illness and Nutrition (CHAIN) Network] study. Data from 5 sites in Uganda, Kenya, and Malawi were included. Hospitalized children aged 2–23 months were followed from an index admission for 6 months after discharge to determine acute and long-term outcomes. Using perinatal HIV exposure (HEU and HUU) as the primary exposure and adjusting for child, caregiver, and household characteristics, we compared inpatient and 30-day survival outcomes, nutritional status, hospital length of stay, illness severity, and utilization of inpatient resources. Results We included 1486 children: 217 HEU and 1269 HUU. HEU children had an increased risk of mortality both during hospitalization [adjusted OR 1.96, 95% CI (1.14–3.37)] and in the 30 days following hospital admission [adjusted hazard ratio 2.20, 95% CI (1.10–4.42)]. Wasting and stunting were more frequent in HEU than HUU children, with adjusted OR 1.41, 95% CI (1.03–1.95) and adjusted OR 1.91, 95% CI (1.34–2.70), respectively. HEU children were also more likely to have a prolonged hospital stay compared to HUU children [adjusted OR 1.58, 95% CI (1.08–2.29)], although admission diagnoses, illness severity at admission, and use of inpatient resources (supplemental oxygen, nasogastric tube, and second-line antibiotics) did not differ significantly between groups. Conclusions HEU children are more likely to die during hospitalization and within 30 days of admission, to be wasted and stunted upon hospital admission, and to require a prolonged hospital stay, as compared to HUU children. Hospitals in settings with a high prevalence of women-living-with-HIV should ensure that maternal HIV status is established among children requiring admission and build capacity to provide additional hospital monitoring and early post-discharge support for HEU children.https://doi.org/10.1186/s12916-024-03790-5HIV exposureMortalityNutritional statusHospital length of stay |
| spellingShingle | Christopher Lwanga Peace Aber Kirkby D. Tickell Moses M. Ngari John Mukisa Michael Atuhairwe Lindsay Brown Ezekiel Mupere Isabel Potani Lubaba Shahrin Brooks Morgan Benson O. Singa Victoria Nankabirwa Richard K. Mugambe Zakaria Mukasa Judd L. Walson James A. Berkley Christina L. Lancioni Impact of HIV exposure without infection on hospital course and mortality among young children in sub-Saharan Africa: a multi-site cohort study BMC Medicine HIV exposure Mortality Nutritional status Hospital length of stay |
| title | Impact of HIV exposure without infection on hospital course and mortality among young children in sub-Saharan Africa: a multi-site cohort study |
| title_full | Impact of HIV exposure without infection on hospital course and mortality among young children in sub-Saharan Africa: a multi-site cohort study |
| title_fullStr | Impact of HIV exposure without infection on hospital course and mortality among young children in sub-Saharan Africa: a multi-site cohort study |
| title_full_unstemmed | Impact of HIV exposure without infection on hospital course and mortality among young children in sub-Saharan Africa: a multi-site cohort study |
| title_short | Impact of HIV exposure without infection on hospital course and mortality among young children in sub-Saharan Africa: a multi-site cohort study |
| title_sort | impact of hiv exposure without infection on hospital course and mortality among young children in sub saharan africa a multi site cohort study |
| topic | HIV exposure Mortality Nutritional status Hospital length of stay |
| url | https://doi.org/10.1186/s12916-024-03790-5 |
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