The influence of HIV-1 seropositivity on survival among children hospitalized with diarrhea in Cite Soleil, Haiti
Description
In the community hospital of Cite Soleil, Haiti, one in 5 children admitted with diarrhea die. This rate was thought to be abnormally high because most of diarrhea mortality can be averted by the use of standard treatment Infection with the Human Immunodeficiency Virus-1 is also a problem in this community. Seroprevalence among pregnant women ranges from 7% to 10% and up to 25% of their offspring are transplacentally infected. Since diarrhea is a common symptom among children infected with HIV, and the case fatality rates continue to be high, assessing the influence of HIV infection on diarrhea mortality was of interest in formulating hypotheses about the high CFR To assess this influence a case-control study was conducted. All children who were admitted from August 1988 to August 1989 with diarrhea and died (n = 117) were compared to a random sample of children admitted during the same period with diarrhea but did not die (n = 218). Demographic variables, variables related to severity of illness and variables related to improper treatment were also assessed so that they could be controlled for in the logistic regression model In addition, since post-hospitalization diarrhea mortality following acute episodes is known to occur, the assessment of the diarrhea mortality rate after discharge was also of interest. To assess post-discharge mortality, a retrospective cohort was conducted on all the children admitted with diarrhea who survived the hospitalization during the August 1988-February 1990 (n = 511). Cox proportional survival analysis was conducted on this group The diarrhea mortality rate was 23.3% and HIV seropositivity was 14.1%. The most common concomitant diagnoses were anemia, marasmus and pneumonia. After controlling for nutritional status, hydration status and chronicity of the diarrhea episode, children who died were 2.4 times more likely to be HIV seropositive than children who survived. The post-discharge diarrhea related mortality rate was 9.5%. After controlling for the nutritional status, and hydration status during their hospitalization, children who died after discharge were almost 4 times more likely to have been HIV seropositive than the children who survived This study demonstrates that children who die are more likely to be HIV seropositive than children who survive both during the hospitalization and after discharge