Skip Navigation LinksHome > March 13, 2013 - Volume 27 - Issue 5 > Health outcomes of HIV-exposed uninfected African infants
AIDS:
doi: 10.1097/QAD.0b013e32835ca29f
Clinical Science

Health outcomes of HIV-exposed uninfected African infants

Kourtis, Athena P.a; Wiener, Jeffreya; Kayira, Dumbanib; Chasela, Charlesb; Ellington, Sascha R.a; Hyde, Lisab; Hosseinipour, Minab,c; van der Horst, Charlesc; Jamieson, Denise J.a

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Abstract

Objectives: To evaluate severe (grade 3/4) morbidity and mortality in HIV-exposed, uninfected infants.

Design: Secondary data analysis of The Breastfeeding, Antiretrovirals, and Nutrition (BAN) clinical trial.

Methods: BAN randomized 2369 mother–infant pairs to maternal, infant, or no extended antiretroviral prophylaxis during breastfeeding. Morbidity outcomes examined were pneumonia/serious febrile illness, diarrhea/growth faltering, and malaria. Infant death was defined as neonatal (≤30 days of life), and postneonatal (31 days to 48 weeks of life). Cox proportional hazards models were used to evaluate the effect of covariates on infant morbidity and mortality.

Results: The rate of pneumonia/serious febrile illness was highest in the first 12 weeks (0.83/100 person-weeks) before rapidly decreasing; rates of all morbidity outcomes increased after 24 weeks. Rates of pneumonia/serious febrile illness and diarrhea/growth faltering were higher during the rainy season. Prophylactic infant cotrimoxazole significantly decreased the rates of all morbidity outcomes. White blood cell (WBC) count less than 9000/μl at birth was associated with increased diarrhea/growth faltering [adjusted hazard ratio (aHR) 1.73, P = 0.04] and malaria (aHR 2.18, P = 0.02). Low birth weight (2000–2499 g) was associated with neonatal death (aHR 12.3, P < 0.001). Factors associated with postneonatal death included rainy season (aHR 4.24, P = 0.002), infant cotrimoxazole (aHR 0.48, P = 0.03), and low infant WBC count at birth (aHR 2.53, P = 0.02).

Conclusion: Infant morbidity rates increased after 24 weeks, when BAN infants weaned. Introduction of prophylactic cotrimoxazole was associated with reduced rates of morbidity and mortality in HIV-exposed uninfected infants. Unexpectedly, a low WBC count at birth was significantly associated with later infant morbidity and mortality in this cohort.

© 2013 Lippincott Williams & Wilkins, Inc.

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