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Child mortality from HIV in the HAART era. CHIVA audit Mich Lajeunesse and Rosanna Crossley. Global deaths from AIDS 1990-2007. UNAIDS data 2007. Global child mortality from HIV. By end 2007 33.2 million infected 2.5 (2.2 -2.6) children 90% African 420k new infections
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Child mortality from HIV in the HAART era CHIVA audit Mich Lajeunesse and Rosanna Crossley
Global deaths from AIDS 1990-2007 UNAIDS data 2007
Global child mortality from HIV • By end 2007 • 33.2 million infected • 2.5 (2.2 -2.6) children • 90% African • 420k new infections • 330k (310-380) deaths • 1 every 90 seconds
CHIPS data • Pre and post ART • 1997 • Reduction in mortality • HR 0.30 (0.19-0.48) • Doerholt 2006 PIDJ • Presented < 12 months • Deaths at 24 months • Pre 97 – 40% • Post – 15%
Three year period N = 11 Causes TB 3 PCP 2 Other infection 4 HIV encephalopathy 1 NHL 1 ONS data in children Doerholt 2006 PIDJ, Ladhani personal communication
BHIVA mortality audit 2004/5 • 12 months throughout UK • N = 387 • 218 (56%) HIV related • Role of HIV in CVS and liver deaths • Late diagnosis featured 35% of HIV related deaths Lucas et al (2008) Clin Med 8:250-2
HIV clinical scenario accounting for death Lucas et al (2008) Clin Med 8:250
BHIVA audit conclusions • HIV testing should be considered as part of all routine consultations
CHIVA mortality audit • UK and Republic or Ireland • 2000 – 2006 • Cases identified through CHIPS, NSHPC and by memory of HCP • Personal identifiers removed • On line audit questionnaire
CHIVA mortality audit • Age / arrival in UK • Cause • Death certification • Availability of PM • Adverse social circ • Eligibility NHS care • CD4 / VL • Growth
Rosanna Crossley Fourth Year Study in Depth
Next steps 13 cases outstanding Collect and review the 13 cases data protection act and patient confidentiality strictly adhered to. 100% of data collected Analyse combined dataset of 52 cases
UNAIDS • Progress in the health sector is key to achieving universal access to HIV/AIDS • prevention • treatment • care http://www.bristol.ac.uk/davidbaumappeal
Acknowledgments • CHIPS • Mike Sharland • Esse Menson • Katja Doerholt • NSHPC • Pat Tookey • Janet Masters • CHIVA • Hermione Lyall • All of you who have supplied data and found cases Mich Mich.Lajeunesse@soton.ac.uk Rosanna rmc105@soton.ac.uk