Mortality increased for infants under 5 with HIV receiving antiretrovirals, research finds

More infants and children aged younger than 5 years with HIV receiving antiretroviral therapy (ART) die compared with those aged 5 years and older receiving ART, according to research published in the Dec. 1 issue of the U.S. Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report.

Nickolas T. Agathis, M.D., from the CDC in Atlanta, and colleagues compared mortality and related clinical measures among infants younger than 1 year and children aged 1 to 4 years living with HIV and receiving ART compared to those of older persons aged 5 to 14, 15 to 49, and 50 years and older living with HIV and receiving ART.

An average of 11,980 infants aged younger than 1 year and 105,510 children aged 1 to 4 years were receiving ART each quarter during October 2020 to September 2022; of these, 4.9 and 2.5 percent, respectively, were reported to have died annually.

The researchers found that compared with the proportions of persons aged 5 years and older receiving ART, the proportions of infants and children who died ranged from four to nine times higher in infants aged younger than 1 year and from two to five times higher in children aged 1 to 4 years.

The proportions of children aged younger than 5 years living with HIV who experienced interruptions in treatment were also higher compared with persons aged 5 years and older, while lower proportions were seen with a documented HIV viral load result or suppressed viral load.

"Prioritizing and optimizing HIV and general health services for children aged <5 years living with HIV receiving ART might help address the disproportionately poorer outcomes they experience," the authors write.