HIV-exposed Uninfected Infant Morbidity and Mortality within a Nationally Representative Prospective Cohort of Mother-Infant Pairs in Zimbabwe, 2013–2014

Details

• Alternative Title:
  AIDS
• Personal Author:
  PATEL, Monita R ; MUSHAVI, Angela ; BALACHANDRA, Shirish ; SHAMBIRA, Gerald ; NYAKURA, Justice ; MUGURUNGI, Owen ; KILMARX, Peter H. ; RIVADENEIRA, Emilia ; DINH, Thu-Ha
• 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.
  
  
• Subjects:
  Child Cohort Studies Female HIV Infections Humans Infant Infant Mortality Infectious Disease Transmission, Vertical Morbidity Mothers Pregnancy Pregnancy Complications, Infectious Prospective Studies

  More +
• Source:
  AIDS. 34(9):1339-1346
• Pubmed ID:
  32590432
• Pubmed Central ID:
  PMC8900086
• Document Type:
  Journal Article
• Funding:
  U2G GH000315/GH/CGH CDC HHSUnited States/
• Place as Subject:
  Zimbabwe
• Volume:
  34
• Issue:
  9
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:59f638ae59069c29b5f694f31019398a2c56136aa9a0872e4f1cb6a5740ae1b6
• Download URL:
  https://stacks.cdc.gov/view/cdc/115242/cdc_115242_DS1.pdf
• File Type:
  [PDF - 718.10 KB ]