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HIV-exposed Uninfected Infant Morbidity and Mortality within a Nationally Representative Prospective Cohort of Mother-Infant Pairs in Zimbabwe, 2013–2014
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7 15 2020
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Source: AIDS. 34(9):1339-1346
[PDF-718.10 KB]
Details:
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Alternative Title:AIDS
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Personal Author:
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Description:Objective:
To examine morbidity and mortality risk among HIV-exposed uninfected (HEU) infants.
Design:
Secondary data analysis of HEU infants in a prospective cohort study of mother-infant pairs.
Methods:
Infants were recruited from immunization clinics (n=151) in Zimbabwe from February-August 2013, enrolled at 4–12 weeks age, and followed every 3 months until incident HIV-infection, death, or 18 months follow-up. We estimated cumulative mortality probability and hazard ratios (HR) with 95% confidence intervals (CI) using Kaplan-Meier curves and Cox regression, respectively. We also described reported reasons for infant hospitalization and symptoms preceding death. Median weight-for-age z-scores (WAZ) and median age were calculated and analyzed across study visits.
Results:
Of 1188 HIV-exposed infants, 73 (6.1%) contracted HIV; we analyzed the remaining 1115 HEU infants. In total, 54 (4.8%) infants died, with median time to death of 5.5 months since birth (IQR:3.6–9.8 months). Diarrhea, difficulty breathing, not eating, fever, and cough were commonly reported (range: 7.4%−22.2%) as symptoms preceding infant death. Low birth weight was associated with higher mortality (adj-HR 2.66, CI:1.35–5.25), while maternal ART pre-delivery (adj-HR 0.34, CI 0.18–0.64) and exclusive breastfeeding (adj-HR 0.50, CI:0.28–0.91) were associated with lower mortality. Overall, 9.6% of infants were hospitalized. Infant median WAZ declined after 3 months of age, reaching a minimum at 14.5 months of age, at which 50% of infants were underweight (WAZ below −2.0).
Conclusions:
Clinical interventions including maternal ART; breastfeeding and infant feeding counseling and support; and early prevention, identification, and management of childhood illness; are needed to reduce HEU infant morbidity and mortality.
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Pubmed ID:32590432
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Pubmed Central ID:PMC8900086
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Volume:34
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Issue:9
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