Morbidity patterns and survival among children living with HIV and HIV-exposed uninfected children in North Karnataka, India: a community-based prospective cohort study

Abstract

Children living with HIV (CLHIV) continue to face high rates of infection and morbidity despite improved ART coverage. This study aimed to (i) compare the prevalence and factors associated with acute morbidities between CLHIV and HIV-exposed uninfected children (HEUC) and (ii) estimate survival probabilities over a two-year follow-up period in a community-based cohort from North Karnataka. This prospective cohort study was conducted in Belagavi district. Data were collected over eight visits between April 2022 and March 2024. Ethical approval was obtained from the Institutional Ethics Committee of KAHER and SNMC, and permission was granted by the Karnataka State AIDS Prevention Society (KSAPS). Multivariable logistic regression was used to assess the association between HIV status and acute morbidities at baseline and endline, adjusting for sociodemographic factors. Survival probabilities were estimated using the Kaplan–Meier method and log-rank test. A total of 348 children (184 CLHIV and 164 HEUC) with complete baseline and endline data were included in the morbidity analysis, whereas 372 children who were followed for their survival were included in the survival analysis. CLHIV were generally older and more often male. Among CLHIV, 19.0% had lost both parents, compared to 6.1% among HEUC. CLHIV showed higher gastrointestinal and skin morbidity. The adjusted odds of morbidity were ~2-fold at baseline and ~3-fold at the endline. Survival remained high (99% at 1 year and 98% at 2 years), with four deaths recorded. This study demonstrates that CLHIV in North Karnataka experience a substantial burden of morbidity. These health challenges are compounded by social factors, such as orphanhood and limited school attendance. The longitudinal design provides important findings to guide policy decisions and health interventions for vulnerable populations.