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Women's morbidity and mortality in the first 2 years after delivery according to HIV status

Coutsoudis, Annaa; England, Kirstyb; Rollins, Nigela; Coovadia, Hoosenc; Newell, Marie-Louiseb,d; Bland, Ruthd,e

doi: 10.1097/QAD.0b013e32834041b7
Epidemiology and Social

Background: Better knowledge of the impact of HIV status on morbidity and mortality patterns of women after delivery is important to improve clinical and policy recommendations.

Methods: Women were enrolled during pregnancy in the Vertical Transmission Study, prior to antiretroviral roll-out in South Africa, and followed for 24 months after delivery. Their health was evaluated by standardized questionnaires and clinical examinations.

Results: Information was available for 2624 women, 50.5% of whom were HIV-infected. Mortality was 8.6 deaths per 1000 person-years in HIV-uninfected, and 55.68 in HIV-infected women. Mortality was associated with antenatal CD4 cell count in HIV-infected women: 171.43/1000 person-years in those with CD4 cell count below 200 compared to 19.35/1000 in those with CD4 cell count at least 200. There was no significant difference between the intensity of breastfeeding during the first 3 months after delivery in women who died and those who survived, regardless of mother's HIV infection status (P = 0.112 and P = 0.530, respectively). Serious morbidity events were documented in 250 of 2624 (9.5%) women; the most common events were bloody diarrhoea (26.4%), pulmonary tuberculosis (24.4%) and an abscess (17.2%). Multivariable Cox regression analysis identified HIV infection, lower levels of education, river/stream water source as risk factors.

Conclusion: HIV-infected women experienced more morbidity and mortality than HIV-uninfected women; this was predicted by maternal immune status and socio-economic factors. HIV-infected women even in the high CD4 strata had higher mortality than HIV-uninfected women from the same population. This study underlines the importance of interventions to improve maternal health, for example timely antiretroviral treatment, tuberculosis screening, and improved water and sanitation.

aDepartment of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa

bCentre for Paediatric Epidemiology and Biostatistics, University of London Institute of Child Health, London, UK

cDirector HIV Management, Reproductive Health, and HIV Research Unit, Durban Branch, University of Witswatersrand, South Africa

dAfrica Centre for Health and Population Studies, University of KwaZulu-Natal, Durban, South Africa

eDivision of Developmental Medicine, Glasgow University Medical Faculty, Glasgow, UK.

Received 28 June, 2010

Revised 19 August, 2010

Accepted 26 August, 2010

Correspondence to Ruth Bland, Africa Centre for Health and Population Studies, PO Box 198, Mtubatuba, Durban 3935, KwaZulu-Natal, South Africa. Tel: +27 35 550 7500; e-mail:

© 2010 Lippincott Williams & Wilkins, Inc.