AIDS and Behavior

, Volume 22, Supplement 1, pp 99–104 | Cite as

Mortality Rate and Predictors in Children Under 15 Years Old Who Acquired HIV from Mother to Child Transmission in Paraguay

  • Gloria Aguilar
  • Angélica Espinosa Miranda
  • George W. Rutherford
  • Sergio Munoz
  • Nancy Hills
  • Tania Samudio
  • Fernando Galeano
  • Anibal Kawabata
  • Carlos Miguel Rios González
Original Paper


We estimated mortality rate and predictors of death in children and adolescents who acquired HIV through mother-to-child transmission in Paraguay. In 2000–2014, we conducted a cohort study among children and adolescents aged < 15 years. We abstracted data from medical records and death certificates. We used the Cox proportional hazards model for the multivariable analysis of mortality predictors. A total of 302 subjects were included in the survey; 216 (71.5%) were younger than 5 years, 148 (51.0%) were male, and 214 (70.9%) resided in the Asunción metropolitan area. There were 52 (17.2%) deaths, resulting in an overall mortality rate of 2.06 deaths per 100 person-years. The children and adolescents with hemoglobin levels ≤ 9 g/dL at baseline had a 2-times higher hazard of death compared with those who had levels > 9 g/dL (HR 2.27, 95% CI 1.01–5.10). The mortality of HIV-infected children and adolescents in Paraguay is high, and anemia is associated with mortality. Improving prenatal screening to find cases earlier and improving pediatric follow-up are needed.


HIV Child Mortality Paraguay 


Estimamos la tasa de mortalidad y los predictores de muerte en niños y adolescentes que contrajeron el VIH por transmisión de madre a hijo en el Paraguay en el periodo entre el 2000-2014 Realizamos un estudio de cohorte entre los niños y adolescentes < 15 años de edad. Se extrajeron los datos clínicos de los registros médicos, y se obtuvieron datos de los registros y certificados de defunción. Utilizamos el modelo de Cox para el análisis multivariado de los predictores de mortalidad. Un total de 302 sujetos fueron incluidos en en el estudio, 216 (71.5%) eran menores de cinco años, 148 (51.0%) fueron varones y 214 (70.9%) vivian en el área metropolitana de Asunción. Se registraron 52 (17.2%) muertes, lo que resultó en una mortalidad general de 2.06 muertes/100 años-persona. Los niños y adolescentes con niveles de hemoglobina basal de  ≤ 9 g/dL tuvieron un riesgo de muerte dos veces mayor en comparación con aquellos con niveles ≥ 9 g/dL (HRo: 2.27; IC 95%, 1.01-5.10). La mortalidad de los niños con VIH en Paraguay es alta y la anemia está asociada con la mortalidad. Se necesita mejorar la atención prenatal para detectar casos en forma más precoz y mejorar el seguimiento pediátrico.


VIH niños y adolescentes mortalidad Paraguay 



We wish to acknowledge support from the University of California, San Francisco’s International Traineeships in AIDS Prevention Studies (ITAPS), U.S. NIMH, R25MH064712 and the Starr Foundation Scholarship Fund.

Compliance with Ethical Standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical Approval

The Ethics Committee of the Institute of Tropical Medicine in Paraguay approved this study.

Informed Consent

For this type of study formal consent is not required.


  1. 1.
    United Nations Joint Programme on HIV/AIDS. Global AIDS Update 2016. Accessed 11 Feb 2017.
  2. 2.
    Hammer S, Gibb D, Havlir D, Mofenson VB, Vella S. Expansion of antiretroviral treatment in environments with limited resources. Guidelines for a public health approach. Geneva: WHO; 2002, pp. 20–26. Accessed 10 Feb 2017.
  3. 3.
    Cotton MF, Violari A, Otwombe K, et al. Early time-limited antiretroviral therapy versus deferred therapy in South African infants infected with HIV: results from the Children with HIV Early Antiretroviral (CHER) randomised trial. Lancet. 2013;382:1555–63.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Violari A, Cotton MF, Gibb DM, et al. Early antiretroviral therapy and mortality among HIV-infected infants. N Engl J Med. 2008;359:2233–44.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Cardoso CA, Pinto JA, Candiani TM, et al. The impact of highly active antiretroviral therapy on the survival of vertically HIV-infected children and adolescents in Belo Horizonte, Brazil. Mem Instituto Oswaldo Cruz. 2012;107:532–8.CrossRefGoogle Scholar
  6. 6.
    Moreira-Silva SF, Zandonade E, Miranda AE. Mortality in children and adolescents vertically infected by HIV receiving care at a referral hospital in Vitória, Brazil. BMC Infect Dis. 2015;15:155.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Rodríguez de Schiavi MS, Scrigni A, García Arrigoni P, et al. Tratamiento antirretroviral de gran actividad en niños VIH positivos: evolución de la enfermedad relacionada con parámetros clínicos, inmunológicos y virológicos al comienzo del tratamiento. Archiv Argentin Pediatria. 2009;107:210–20.Google Scholar
  8. 8.
    Panamerican Health Organization. Indicadores básicos de salud Paraguay, 2016. Washington, DC: Pan American Health Organization, 2016. Accessed 10 Jan 2017.
  9. 9.
    Ministerio de Salud Pública y Bienestar Social (MSPyBS). Situación epidemiológica del VIH, Paraguay 2015. Asunción, Paraguay: MSPyBS, 2015. Accessed 10 Feb 2017.
  10. 10.
    Panel on Antiretroviral Therapy and Medical Management of HIV-Infected Children. Guidelines for the use of antiretroviral agents in pediatric HIV infection. Accessed 26 Oct 2016.
  11. 11.
    Brady MT, Oleske JM, Williams PL, et al. Declines in mortality rates and changes in causes of death in HIV-1–infected children during the HAART era. J Acquir Immune Defic Syndr. 2010;53:86–94.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Badie BM, Nabaei G, Rasoolinejad M, Mirzazadeh A, McFarland W. Early loss to follow-up and mortality of HIV-infected patients diagnosed after the era of antiretroviral treatment scale up: a call for re-invigorating the response in Iran. Int J STD AIDS. 2013;24:926–30.CrossRefPubMedGoogle Scholar
  13. 13.
    Mofenson LM, Korelitz J, Meyer WA 3rd, et al. The relationship between serum human immunodeficiency virus type 1 (HIV-1) RNA level, CD4 lymphocyte percent, and long-term mortality risk in HIV-1–infected children. National Institute of Child Health and Human Development Intravenous Immunoglobulin Clinical Trial Study Group. J Infect Dis. 1997;175:1029–38.CrossRefPubMedGoogle Scholar
  14. 14.
    Abrams EJ, Weedon J, Steketee RW, et al. Association of human immunodeficiency virus (HIV) load early in life with disease progression among HIV-infected infants. New York City Perinatal HIV Transmission Collaborative Study Group. J Infect Dis. 1998;178:101–8.CrossRefPubMedGoogle Scholar
  15. 15.
    Palumbo PE, Raskino C, Fiscus S, et al. Predictive value of quantitative plasma HIV RNA and CD4 + lymphocyte count in HIV-infected infants and children. JAMA. 1998;279:756–61.CrossRefPubMedGoogle Scholar
  16. 16.
    Ministerio de Salud Pública y Bienestar Social (MSPyBS), Pan American Health Organization. Perfil de salud de la niñez de Paraguay. Paraguay, 2011. Asunción, Paraguay: Subsistema de Información de las Estadísticas Vitales, Dirección de Bioestadística, MSPyBS, 2009. Accessed 28 Mar 2017.
  17. 17.
    United Nations Joint Programme on HIV/AIDS. On the fast-track to an AIDS-Free Generation 2016. Accessed 30 Mar 2017.

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Gloria Aguilar
    • 1
    • 2
    • 3
  • Angélica Espinosa Miranda
    • 3
  • George W. Rutherford
    • 4
  • Sergio Munoz
    • 5
  • Nancy Hills
    • 6
  • Tania Samudio
    • 2
  • Fernando Galeano
    • 7
  • Anibal Kawabata
    • 8
  • Carlos Miguel Rios González
    • 8
  1. 1.Research Directorate GeneralNational University of CaaguazúCoronel OviedoParaguay
  2. 2.Department of Strategic Information and Surveillance, National HIV ProgramAsunciónParaguay
  3. 3.Post Graduation Program in Infectious DiseasesFederal University of Espirito SantoVitoriaBrazil
  4. 4.Global Health Sciences, University of CaliforniaSan FranciscoUSA
  5. 5.Department of Public HealthUniversity of the FrontierTemucoChile
  6. 6.Department of Epidemiology and BiostatisticsUniversity of California San FranciscoSan FranciscoUSA
  7. 7.Department of PediatricsInstitute of Tropical MedicineAsunciónParaguay
  8. 8.Faculty of Medical SciencesNational University of CaaguazúCoronel OviedoParaguay

Personalised recommendations