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, D.; Wang, L.; Brown, L.; Taha, T.; Valentine, M.; Emel, L.; Sinkala, M.; Kafulafula, G.; Noor, R.A.; Read, J.S.; Brown, E.R.; Goldenberg, R.L.; Hoffman, I.; Taha, T.E.; Goldenberg, R.; Kumwenda, N.; Kafulafula, G.; Martinson, F.; Msamanga, G.; Sinkala, M.; Stringer, J.; Hoffman, I.; Fawzi, W.; Broadhead, R.; Liomba, G.; Kumwenda, J.; Mebrahtu, T.; Katunda, P.; Dahab, M.; Kazembe, P.; Chilongozi, D.; Chasela, C.; Joaki, G.; Dzinyemba, W.; Kamanga, S.; Lyamuya, E.; Kilewo, C.; Manji, K
Pediatric Infectious Disease Journal 27(9): 808-814
2008
ISSN/ISBN: 0891-3668 PMID: 18679152 DOI: 10.1097/inf.0b013e31817109a4Document Number: 202490
Morbidity and mortality patterns among pregnant women and their infants (before antiretroviral therapy was widely available) determines HIV-1 diagnostic, monitoring, and care interventions. 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. 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. 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.