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Pediatric Infectious Disease Journal:
doi: 10.1097/INF.0b013e31817109a4
Original Studies

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

Chilongozi, David CO, MPH*; Wang, Lei PhD†; Brown, Lillian MPH‡§; Taha, Taha MD, PhD∥; Valentine, Megan PA-C, MS¶; Emel, Lynda PhD†; Sinkala, Moses MD, MPH#**; Kafulafula, George MBBS, FCOG††; Noor, Ramadhani A. MD, MPH‡‡; Read, Jennifer S. MD, MS, MPH, DTM&H, MS§§; Brown, Elizabeth R. ScD∥∥; Goldenberg, Robert L. MD**; Hoffman, Irving PA, MPH§; for the HIVNET 024 Study Team

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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.

© 2008 Lippincott Williams & Wilkins, Inc.

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