A study on the effect of HIV infection on the duration of the stabilization phase of children with severe acute malnutrition at the University Teaching Hospital, department of paediatrics and child health, Lusaka, Zambia

Abstract

Title: The Effect of HIV Infection on the Duration of the Stabilization Phase in Children with Severe Acute Malnutrition at the University Teaching Hospital, Lusaka, Zambia. Background: Severe Acute Malnutrition (SAM) is a major cause of under 5 mortality in developing countries. The prevalence of HIV infection in children with SAM is high. HIV infection complicates the clinical presentation and outcome of SAM. The aim of this study was to determine the effect of HIV infection on the duration of the stabilization phase in children with SAM admitted to the malnutrition ward at the University Teaching Hospital, Lusaka. Specifically the study compared the duration of the stabilization phase between HIV-infected and HIV-uninfected children with SAM, mortality between these two groups and determined whether being on Highly Active Antiretroviral Therapy (HAART) had an effect on the duration of the stabilization phase. Methods: In this analytical observational cohort study, children were recruited from the malnutrition ward at UTH from November 2014 to April 2015. The HIV status of each child was determined using age appropriate methods in order to assign to a corresponding arm of the study depending on the result. Enrolled children were followed up until stabilization was achieved. The number of days to stabilization and mortality in each arm was recorded over this period. Results: A total of 170 children were recruited. There were 87 males and 83 females. The median age was 19 months (IQR 6, 49). There were 90 patients (52.9%) that were HIV-infected and 80 patients (47.1%) that were HIV-uninfected. There were 84 children (49.4%) with marasmus and 57 children (33.5%) with kwashiorkor. A total of 95 children (55.9%) were severely stunted. The mean number of days to stabilization was 6.7 days in the HIV infected children and 4.9 days in the HIV-uninfected (P-value <0.01). The mortality rate in the HIV-infected children was 17.8% compared to 7.5% in the HIV-uninfected children (P-value= 0.05). The mean number of days to stabilization was 5.8 days in the children on HAART and 6.6 days in the children not on HAART (P-value=0.36). Conclusion: The study shows that HIV infection prolongs the duration of the stabilization phase and the mortality is higher in the HIV-infected children. It also shows that being on HAART doesn’t affect the duration of the stabilization phase.