Journal of Tropical Pediatrics Advance Access originally published online on June 9, 2005
Journal of Tropical Pediatrics 2006 52(1):3-11; doi:10.1093/tropej/fmi047
The First 5 Years of the Family Clinic for HIV at Tygerberg Hospital: Family Demographics, Survival of Children and Early Impact of Antiretroviral Therapy
a Amsterdam Medical Center, University of Amsterdam, Netherlands b Departments of Paediatrics & Child Health and c Internal Medicine, Faculty of Health Sciences, Stellenbosch University, South Africa d Department of Social Work, Tygerberg Academic Hospital, South Africa e Departments of Human Biology and f Statistical Sciences, University of Cape Town, South Africa
Correspondence: Dr Mark Cotton, KID-CRU (Children's Infectious Diseases Clinical Research Unit), Department of Paediatrics and Child Health, Faculty of Health Sciences, Stellenbosch University, PO Box 19063, Tygerberg 7505, South Africa. E-mail <mcot{at}sun.ac.za>.
Background: Family clinics address the problems of HIV-infected children and their families. The aims were to document demographics of the children and caregivers attending the Family Clinic for HIV at Tygerberg Academic Hospital (TAH) and to investigate factors affecting disease progression in children.
Methods: A retrospective folder review of children and parents attending the Family Clinic at TAH between January 1997 and December 2001, a period noted for its lack of antiretroviral treatment.
Results: Of 432 children seen for testing, 274 children, median age 16.9 months, were HIV-infected. During follow-up, 46 children died (median age 23 months) and 113 were lost to follow-up. The majority of children were malnourished. Those <2 years of age had lower weight for age Z-scores (WAZ) than older children (p<0.001). At presentation, 47 per cent were in clinical stage B and two-thirds had moderate or severe CD4+ T cell depletion. Seventeen children had received highly active antiretroviral therapy (HAART), 12 dual and 31 monotherapy. HAART was associated with improved survival compared to dual or monotherapy. Risk of death was reduced from eleven-fold for a WAZ <–4 to four-fold between –2 and –3. There was no association with immunological and clinical classification at entry and risk of mortality. Only 18 per cent of parents were evaluated in the clinic. Non-parental care was documented for 25 per cent of families.
Conclusions: A low WAZ is associated with poor survival in children. Nutritional status should receive more attention in HIV disease classification in children. Parent utilization of the clinic was inadequate. Even in the absence of HAART, extended survival in children is possible.