ArticleThe Southern African journal of critical care : the official journal of the Critical Care Society2025
Outcomes of HIV-exposed infected and HIV-exposed uninfected children admitted to two paediatric intensive care units in South Africa: A retrospective analytical cohort study.
Article in The Southern African journal of critical care : the official journal of the Critical Care Society, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Reduced vertical transmission of HIV has led to an increased proportion of HIV-exposed uninfected children (HEU) in South Africa. Increased infective morbidity and mortality creates a need to better understand outcomes and morbidity in this population. Objectives: To describe and compare critical care outcomes in terms of survival and disease severity between HIV-unexposed children (HUU), HIV-exposed infected children (HEI) and HEU. Methods: A retrospective analytical cohort study was carried out from 1 January 2017 to 31 December 2021. Paediatric intensive care unit admissions of children aged 1 month - 5 years were included. Outcomes for HEU and HEI were compared with those of HUU, with a significance threshold set at p=0.05. Multivariate logistic regression analysis was conducted. Results: Of 1 015 children, 633 (62.4%) were HUU, 318 (31.3%) were HEU and 64 (6.3%) were HEI. Mortality was higher in HEU (15.8%; p=0.1) and HEI (17.2%; p=0.4) compared with HUU (11.4%), but this was not statistically significant. HEU and HEI were younger (p<0.001) and more frequently underweight (p<0.001). HEU (and HEI) had an increased risk of acute kidney injury (AKI) (odds ratio 1.19; 95% confidence interval 1.07 - 1.81; p=0.014) and a lower minimum estimated glomerular filtration rate (p<0.001) compared with HUU. Septic shock was more frequent in HEU (28.6%; p=0.001) and HEI (43.8%; p<0.001) compared with HUU (20.1%). HEI had more frequent mechanical ventilation (p=0.003), more prolonged mechanical ventilation (p<0.001) and lower admission haemoglobin concentrations (p<0.001) than HUU. Conclusion: Compared with HUU, both HEU and HEI demonstrated a trend towards increased mortality, but this was not statistically significant. HEU and HEI experienced increased AKI and other morbidity. Contribution of the study: This study provides the largest report of outcomes in HIV-exposed uninfected children (HEU) to date. The study provides new data suggesting that HEU may be at increased risk of acute kidney injury.
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