Association of HIV-1 load and CD4 lymphocyte count with mortality among untreated African children over one year of age

Objective: To examine the association of viral load and CD4 lymphocyte coun t with mortality among HIV-infected children over one year of age. Design: A prospective study. HIV-infected children were enrolled during the first year of life and followed for more than 2 years at the Queen Elizabe th Central Hospital in Blantyre, Malawi (southeast Africa). Methods: Morbidity and mortality information was collected every 3 months, and physical examination and blood testing (for viral level and CD4 cell pe rcentage) were performed every 6 months. Kaplan-Meier analyses and proporti onal hazards models were used to estimate survival and to examine the assoc iation of primary predictors with mortality. Results: Of 155 HIV-infected children originally enrolled, 115 (74%) had vi ral load testing and 82 (53%) had both viral load and CD4 cell percentage t esting after their first year. Among children over one year of age, signifi cant associations were found between mortality and the log(10) viral load a nd CD4 cell percentage in both univariate and multivariate models. Independ ent of the CD4 cell value, a one unit log(10) increase in HIV RNA level inc reased the hazard of child mortality by more than twofold. Children with lo w CD4 cell counts (< 15%) and high viral loads (greater than or equal to 25 0 000 copies/ml median value) had the worst survival; children with high CD 4 cell counts (greater than or equal to 15%) and low viral loads (< 250 000 copies/ml) had the best survival. Conclusion: As in developed countries, viral load and CD4 cell count are th e main predictors of mortality among African children. Making these tests a vailable adds to the challenges to be considered if antiviral therapies wer e to be adopted in these countries. (C) 2000 Lippincott Williams & Wilkins.