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Impact of HIV infection and exposure on survival in critically ill children who attend a paediatric emergency department in a resource-constrained setting
  1. S Ahmad1,2,3,
  2. J C Ellis1,4,
  3. H Kamwendo2,
  4. E M Molyneux1,2
  1. 1Paediatric Department, College of Medicine, Blantyre, Malawi
  2. 2Accident and Emergency Department, Queen Elizabeth Central Hospital, Blantyre, Malawi
  3. 3Emergency Department, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
  4. 4Paediatric Department, Kings Mill Hospital, Sherwood Hospitals NHS Foundation Trust, Mansfield, UK
  1. Correspondence to Dr Shafique Ahmad, Emergency Department, Queens Medical Centre, Nottingham, UK; Shafique.ahmad{at}nuh.nhs.uk

Abstract

Objective To assess the impact of HIV infection and exposure on survival in critically ill children requiring resuscitation.

Methods A 6-month descriptive prospective cohort study of all live admissions to the resuscitation room of an urban paediatric emergency department in Blantyre, Malawi.

Results 583 children were resuscitated, of whom 401 (69%) survived to hospital discharge. 26% of all children tested positive for HIV infection (152/576), and this was highest in patients presenting with shock (66%; 162/247), clinically diagnosed septicaemia (57%; 125/218) and malnutrition (40%; 24/60). Of 152 HIV-seropositive children, 30 (20%) died within 24 h, while among 424 seronegative children 36 (8.4%) died within 24 h (p<0.001). Later deaths (>24 h) were also more common in HIV-seropositive children compared with HIV-uninfected patients (24.3% vs 12.3%; p<0.001). Survival to 24 h was 80% (122/152) and to discharge 56% (85/152) in HIV-seropositive children. In HIV-uninfected children survival to 24 h was 92% (388/424) and to discharge 79% (336/424).

Conclusion Early and late case death rates are greater in HIV-seropositive than in HIV-uninfected children. 80% of HIV-infected children survived the period most influenced by the process of resuscitation, that is, the first 24 h. HIV status alone should not influence the limitation of intervention decisions in the resuscitation room when faced with a critically ill child.

  • critical illness
  • HIV infection
  • paediatric emergency medicine

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Footnotes

  • Funding HIV-1 and HIV-2 test cards (Determine, Abbott Laboratories, Tokyo, Japan) were used to assess HIV serological status. These were partly funded by a College of Emergency Medicine (UK) academic grant.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the College of Medicine Research and Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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