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Maternal Disease Stage and Child Undernutrition in Relation to Mortality Among Children Born to HIV-Infected Women in Tanzania

Chatterjee, Anirban MD, DSc*; Bosch, Ronald J PhD†; Hunter, David J MD, ScD*‡; Fataki, Maulidi R MD, MMed§; Msamanga, Gernard I MD, ScD∥; Fawzi, Wafaie W MD, DrPH*‡

JAIDS Journal of Acquired Immune Deficiency Syndromes: 15 December 2007 - Volume 46 - Issue 5 - pp 599-606
doi: 10.1097/QAI.0b013e31815a5703
Epidemiology and Social Science

Objective: To examine whether maternal HIV disease stage during pregnancy and child malnutrition are associated with child mortality.

Design: Prospective cohort study in Tanzania.

Methods: Indicators of disease stage were assessed for 939 HIV-infected women during pregnancy and at delivery, and children's anthropometric status was obtained at scheduled monthly clinic visits after delivery. Children were followed up for survival status until 24 months after birth.

Results: Advanced maternal HIV disease during pregnancy (CD4 count <350 vs. ≥350 cells/mm3) was associated with increased risk of child mortality through 24 months of age (hazard ratio [HR] = 1.74, 95% confidence interval [CI]: 1.32 to 2.30). CD4 count <350 cells/mm3 was also associated with an increased risk of death among children who remained HIV-negative during follow-up (HR = 2.00, 95% CI: 1.36 to 2.94). Low maternal hemoglobin concentration and child undernutrition were related to an increased risk of mortality in this cohort of children.

Conclusions: Low maternal CD4 cell count during pregnancy is related to increased risk of mortality in children born to HIV-infected women. Care and treatment for HIV disease, including highly active antiretroviral therapy to pregnant women, could improve child survival. Prevention and treatment of undernutrition in children remain critical interventions in settings with high HIV prevalence.

From the *Department of Epidemiology, Harvard School of Public Health, Boston, MA; †Department of Biostatistics, Harvard School of Public Health, Boston, MA; ‡Department of Nutrition, Harvard School of Public Health, Boston, MA; §Department of Pediatrics and Child Health, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania; and the ∥Department of Community Health Sciences, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania.

Received for publication March 19, 2007; accepted September 5, 2007.

Correspondence to: Anirban Chatterjee, MD, DSc, c/o Wafaie Fawzi, Department of Nutrition, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115 (e-mail: mina@hsph.harvard.edu).

© 2007 Lippincott Williams & Wilkins, Inc.