Post-mortem characterisation of HIV-associated under-5 deaths in the CHAMPS network: population-based mortality surveillance.
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Mandomando Inacio, Madewell Zachary J, Mutevedzi Portia C, Igunza Kitiezo Aggrey, Onyango Dickens, Rogena Emily A, Were Joyce, Nhampossa Tacilta, Torres-Fernandez David, Varo Rosauro, Xerinda Elisio G, Dangor Ziyaad, Madhi Shabir A, Mahtab Sana, Sorour Gillian, Dempster Megan, Lakoh Sulaiman, Ameh Soter, Ogbuanu Ikechukwu Udo, Ojulong Julius, Samura Solomon, Keita Adama Mamby, Kotloff Karen L, Sidibe Diakaridia, Sow Samba O, Tapia Milagritos D, Assefa Nega, Demessie Daniel, Madrid Lola, Scott J Anthony G, Wakwaya Getahun, El Arifeen Shams, Gurley Emily S, Tippett Barr Beth A, Whitney Cynthia G, Blau Dianna M, Bassat Quique, Akelo Victor, Child Health and Mortality Prevention Surveillance network
Аннотация
METHODS: We conducted a prospective, descriptive analysis of deaths in children younger than 5 years (under-5) recorded from Dec 3, 2016, to Dec 31, 2024, across seven CHAMPS sites in Ethiopia, Kenya, Mali, Mozambique, Sierra Leone, South Africa, and Bangladesh. Causes of death were determined through standardised post-mortem investigations using minimally invasive tissue sampling, histopathology, molecular testing, clinical record abstraction, and verbal autopsy. Multidisciplinary panels adjudicated causes of death, and descriptive statistics were used to summarise demographic, clinical, and laboratory findings.
FINDINGS: Of 5200 under-5 deaths with an assigned cause, 164 (3·2%) had HIV in the causal chain-two neonatal and 162 infant or child deaths. 31 additional infants and children with HIV had HIV listed as a contributing condition only. Among infants and children, HIV-attributed mortality was highest in Mozambique (38 [13%] of 296), Kenya (41 [8%] of 499), Sierra Leone (39 [8%] of 500), Mali (13 [8%] of 168), and South Africa (30 [8%] of 399), and was rare in Ethiopia (one [1%] of 140) and absent in Bangladesh (none of 15). Only 94 (58%) of 162 HIV-attributed cases had documented antemortem diagnoses; of those, 63 (67%) had received antiretroviral therapy. Comorbidities included lower respiratory infections (84 [52%] of 162), sepsis (70 [43%]), malaria (27 [17%]), diarrhoeal diseases (26 [16%]), anaemia (22 [14%]), other infections (22 [14%]), and meningitis or encephalitis (15 [9%]). Wasting syndrome was present in 89 (55%) of 162, and 144 (89%) of 162 had other infections in the causal chain, including cytomegalovirus (48 [30%] of 162), Klebsiella pneumoniae (48 [30%]), Streptococcus pneumoniae (30 [19%]), and Pneumocystis jirovecii (24 [15%]).
INTERPRETATION: Paediatric HIV remains a major contributor to under-5 mortality in high-burden settings, often alongside co-infections and malnutrition. Low diagnosis and treatment rates reflect missed care opportunities. Strengthening early detection, treatment, and maternal-child health services is essential to reducing deaths and achieving global HIV targets.
FUNDING: Bill & Melinda Gates Foundation.