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Child mortality from HIV in the HAART era

Child mortality from HIV in the HAART era. CHIVA audit Mich Lajeunesse and Rosanna Crossley. Global deaths from AIDS 1990-2007. UNAIDS data 2007. Global child mortality from HIV. By end 2007 33.2 million infected 2.5 (2.2 -2.6) children 90% African 420k new infections

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Child mortality from HIV in the HAART era

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  1. Child mortality from HIV in the HAART era CHIVA audit Mich Lajeunesse and Rosanna Crossley

  2. Global deaths from AIDS 1990-2007 UNAIDS data 2007

  3. Global child mortality from HIV • By end 2007 • 33.2 million infected • 2.5 (2.2 -2.6) children • 90% African • 420k new infections • 330k (310-380) deaths • 1 every 90 seconds

  4. CHIPS data • Pre and post ART • 1997 • Reduction in mortality • HR 0.30 (0.19-0.48) • Doerholt 2006 PIDJ • Presented < 12 months • Deaths at 24 months • Pre 97 – 40% • Post – 15%

  5. Three year period N = 11 Causes TB 3 PCP 2 Other infection 4 HIV encephalopathy 1 NHL 1 ONS data in children Doerholt 2006 PIDJ, Ladhani personal communication

  6. BHIVA mortality audit 2004/5 • 12 months throughout UK • N = 387 • 218 (56%) HIV related • Role of HIV in CVS and liver deaths • Late diagnosis featured 35% of HIV related deaths Lucas et al (2008) Clin Med 8:250-2

  7. HIV clinical scenario accounting for death Lucas et al (2008) Clin Med 8:250

  8. BHIVA audit conclusions • HIV testing should be considered as part of all routine consultations

  9. CHIVA mortality audit • UK and Republic or Ireland • 2000 – 2006 • Cases identified through CHIPS, NSHPC and by memory of HCP • Personal identifiers removed • On line audit questionnaire

  10. CHIVA mortality audit • Age / arrival in UK • Cause • Death certification • Availability of PM • Adverse social circ • Eligibility NHS care • CD4 / VL • Growth

  11. Rosanna Crossley Fourth Year Study in Depth

  12. Deaths with HIV infection

  13. Next steps 13 cases outstanding Collect and review the 13 cases data protection act and patient confidentiality strictly adhered to. 100% of data collected Analyse combined dataset of 52 cases

  14. UNAIDS • Progress in the health sector is key to achieving universal access to HIV/AIDS • prevention • treatment • care http://www.bristol.ac.uk/davidbaumappeal

  15. Acknowledgments • CHIPS • Mike Sharland • Esse Menson • Katja Doerholt • NSHPC • Pat Tookey • Janet Masters • CHIVA • Hermione Lyall • All of you who have supplied data and found cases Mich Mich.Lajeunesse@soton.ac.uk Rosanna rmc105@soton.ac.uk

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