OA-429 High mortality in African infants living with HIV hospitalized with severe pneumonia

• Published in: BMJ global health Vol. 8; no. Suppl 10; p. A15
• Main Authors: Nduna, Bwendo, Moraleda, Cinta, Sacaral, Jahit, Beinomugisha, Judith, Zulu, Idah, Chitamatanga, Moses, Tam, Pui-Ying Iroh, Chawinga, Chimwemwe, Fernandez, Sheila, Ballesteros, Álvaro, Passanduca, Alfeu, Tagoola, Abner, Atibo, Raul, Nansera, Denis, Bwakura-Dangarembizi, Mutsa, Gambi, Lughano, Mvalo, Tisungane, Madrid, Lola, Macmillan, Belinda, Musiime, Victor, Moh, Raoul, Buck, Chris W, Chabala, Chishala, Tagarro, Alfredo, Rojo, Pablo, Empirical, Trial
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd 17.12.2023; BMJ Publishing Group LTD
• Subjects: Abstracts of Oral Presentations; Cytomegalovirus; HIV; Hospitalization; Human immunodeficiency virus; Mortality; Pneumonia; Tuberculosis
• ISSN: 2059-7908
• DOI: 10.1136/bmjgh-2023-EDC.34

BackgroundChildren with advanced HIV disease (AHD) are at an increased risk of morbidity and mortality. We describe mortality rates among infants with AHD hospitalized with severe pneumonia.MethodsEMPIRICAL is an ongoing Phase II-III, open-label randomized factorial (2×2) trial supported by EDCTP (GA RIA2017MC_2013/#NCT03915366) to assess the impact of empirical treatment against cytomegalovirus and tuberculosis in infants living with HIV hospitalized with severe pneumonia. The primary endpoint is all-cause mortality at 15-days and 12-months post enrolment. Recruitment is on-going and includes 22 hospitals from 6 African countries (Côte d’Ivoire, Malawi, Mozambique, Uganda, Zambia, Zimbabwe). ResultsIn March 2023, 431 infants had been recruited and 429 were included in analysis. Their median age was 4.36 months (IQR, 3.18–7.08) and 49% were female; 164 (38%) had a history of maternal and/or infant prophylaxis for prevention-mother-to-child-transmission (PMTCT); 306 (71%) were newly diagnosed of HIV during hospitalization; Median HIV viral load and CD4% were 6.3 logs copies/mL (IQR, 5.8–7.0) and 14.4% (IQR, 9.9–21.6) respectively. 196 (46%) of the infants died within a 6 months follow up period (2.16 months (IQR, 0.26–6.16), 110 (56%) in the first admission and 86 (44%) after it. The main register causes of death are pneumonia 91 (46%), sepsis 32 (16%) and gastroenteritis 10 (5%). An in-depth analysis of deaths is ongoing, including minimally invasive tissue sampling, microbiological and histopathological evaluation.ConclusionChildren living with HIV and severe pneumonia have a very high mortality, both during the initial hospitalization and after hospital discharge. Measures focused on earlier identification and treatment as well as focused on decreasing post-discharge mortality are urgently needed. EMPIRICAL will report on the survival benefit of cytomegalovirus and tuberculosis treatment at trial conclusion. Emphasis should be put into reducing missed opportunities for PMTCT; strengthening early infant diagnosis and antiretrovirals initiation for those who fail PMTCT.