Causes of death in HIV-infected and HIV-uninfected children in the child health and mortality prevention surveillance study-Kenya.

OBJECTIVES Describe the causes of death among infants and children <5 years stratified by HIV status. DESIGN Cross-sectional analysis of causes of death ascertained through minimally invasive tissue sampling (MITS) in the Kenya Child Health and Mortality Prevention Surveillance site. METHODS We included decedents aged 28 days to <5 years, whose death was reported within 36 hours, underwent MITS, and had HIV test results and causes of death determined. MITS specimens were tested using Taqman Array Cards, culture, cytology, histopathology and immunohistochemistry and HIV polymerase chain reaction. A panel evaluated epidemiologic, clinical, verbal autopsy and laboratory data to assign causes of death using ICD10 guidelines. Causes of death and etiological agents were stratified by HIV status. RESULTS Of 176 included decedents, 14% (n = 25) were HIV-infected, median viral load was 112,205 copies per milliliter (interquartile range [IQR] = 9,349-2,670,143). HIV-disease (96%; n = 24) and malnutrition (23%; n = 34) were the leading underlying causes of death in HIV-infected and HIV-uninfected decedents, respectively. Malnutrition was more frequent in the causal chain of HIV-infected (56%; n = 14) than HIV-uninfected decedents (31%; n = 49) (p-value = 0.03). Viral pneumonia was twice as common in HIV-infected (50%; n = 9) than HIV-uninfected decedents (22%; n = 7) (p-value = 0.04). CONCLUSION Nearly all HIV-infected decedents' underlying cause of death was HIV disease which was associated with malnutrition. Our findings underscore the need for strengthening early identification and management of HIV-infected children. Prevention, early diagnosis and treatment of malnutrition could be instrumental in improving the survival of HIV-infected and HIV-uninfected children.