Morbidity and mortality among a cohort of human immunodeficiency virus type 1-infected and uninfected pregnant women and their infants from Malawi, Zambia, and Tanzania
Title | Morbidity and mortality among a cohort of human immunodeficiency virus type 1-infected and uninfected pregnant women and their infants from Malawi, Zambia, and Tanzania |
Publication Type | Journal Article |
Year of Publication | 2008 |
Authors | Chilongozi, D, Wang, L, Brown, L, Taha, T, Valentine, M, Emel, L, Sinkala, M, Kafulafula, G, Noor, RA, Read, JS, Brown, ER, Goldenberg, RL, Hoffman, I, Team, HS |
Journal | The Pediatric infectious disease journal |
Volume | 27 |
Pagination | 808-814 |
Date Published | Sep |
ISBN Number | 0891-3668; 0891-3668 |
Accession Number | 18679152 |
Keywords | Adult, Anti-Bacterial Agents/therapeutic use, CD4 Lymphocyte Count, Female, HIV Infections/epidemiology/mortality/prevention & control/transmission, HIV-1/isolation & purification, Humans, Infant, Infant, Newborn, Infectious Disease Transmission, Vertical/prevention & control, Longitudinal Studies, Malawi, Multivariate Analysis, Pregnancy, Pregnancy Complications, Infectious/epidemiology/mortality, Pregnant Women, Proportional Hazards Models, Risk Factors, Survival Analysis, tanzania, Time Factors, Viral Load, Zambia |
Abstract | BACKGROUND: Morbidity and mortality patterns among pregnant women and their infants (before antiretroviral therapy was widely available) determines HIV-1 diagnostic, monitoring, and care interventions. METHODS: Data from mothers and their infants enrolled in a trial of antibiotics to reduce mother-to-child-transmission of HIV-1 at 4 sub-Saharan African sites were analyzed. Women were enrolled during pregnancy and follow-up continued until the infants reached 12 months of age. We describe maternal and infant morbidity and mortality in a cohort of HIV-1-infected and HIV-1-uninfected mothers. Maternal and infant factors associated with mortality risk in the infants were assessed using Cox proportional hazard modeling. RESULTS: Among 2292 HIV-1-infected mothers, 166 (7.2%) had a serious adverse event (SAE) and 42 (1.8%) died, whereas no deaths occurred among the 331 HIV-1 uninfected mothers. Four hundred twenty-four (17.8%) of 2383 infants had an SAE and 349 (16.4%) died before the end of follow-up. Infants with early HIV-1 infection (birth to 4-6 weeks) had the highest mortality. Among infants born to HIV-1-infected women, maternal morbidity and mortality (P = 0.0001), baseline CD4 count (P = 0.0002), and baseline plasma HIV-1 RNA concentration (P < 0.0001) were significant predictors of infant mortality in multivariate analyses. CONCLUSIONS: The high mortality among infants with early HIV-1 infection supports access to HIV-1 diagnostics and appropriate early treatment for all infants of HIV-1-infected mothers. The significant association between stage of maternal HIV-1 infection and infant mortality supports routine CD4 counts at the time of prenatal HIV-1 testing. |
PMCID | 2739309 |