Causes of adverse outcomes in children with perinatal contact for HIV infection

• Elena S. Dovgopoljuk
• Larisa V. Puzyreva

Abstract

The HIV pandemic is a serious problem for society and healthcare systems, both worldwide and in Russian Federation. Prevention of perinatal HIV transmission is an integral part of prevention programs and its effectiveness depends on the completeness and timeliness of its implementation. Infants who have had perinatal HIV exposure need early diagnosis of HIV infection and timely treatment.

The aim of the study was to analyze the causes and predictors of death in children with perinatal HIV exposure.

Material and methods. An analysis of data on children born to HIV-infected mothers in the Siberian Federal District for 2009–2018 was carried out. Cases of deaths among children with a confirmed diagnosis of HIV infection (n=91) were identified for this period. Reporting and accounting statistical forms were used, as well as materials from sentinel epidemiological surveillance (operational reports on the death of an HIV patient).

Particular attention was paid to children who died from HIV infection, when the causes of death associated with and unrelated to HIV infection were considered.

Statistical data analysis was carried out in MS Excel 2010. The obtained results were statistically processed with the calculation of extensive indicators and Spearman’s rank correlation coefficient (Statistica 13.3 software package). The absolute risk for HIV infection in children born to HIV-infected mothers was calculated.

Results and discussion. Among the dead (n=91), 82.4% of children did not live to the age of two, postmortem diagnosis of HIV infection was established in 12.1% of cases. In the structure of causes associated with HIV infection, opportunistic infections accounted for 57.9%. Against the background of acute HIV infection, death was registered in 63.2%, and in the stage of secondary diseases in 36.8% of cases.

Chemoprophylaxis of HIV transmission from mother to child in full (during pregnancy, childbirth and newborn) was carried out only by 44.0% of mother–child pairs. HIV infection was detected after childbirth (30.8%) in every third woman, while breastfeeding was carried out in 13.2% of cases. Premature births were in 28.6% of women, and 29.7% of children were born by caesarean section.

Correlation analysis was used to identify predictors of adverse outcomes in the first five years of life in HIV-infected children who became infected from their mothers.

Conclusion. The main cause of death in almost all children with HIV infection was the progression of the underlying disease. Our results highlight the need to strengthen the early detection and management of HIV-infected children. Prevention, early diagnosis and timely treatment can achieve zero rates for HIV infection in children.

Keywords:HIV infection; prevention of vertical HIV transmission; child mortality; pneumonia; breastfeeding; caesarean section

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