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. 2007 Oct 1;46(2):208-15.
doi: 10.1097/QAI.0b013e318141fcc0.

Morbidity among HIV-1-infected mothers in Kenya: prevalence and correlates of illness during 2-year postpartum follow-up

Judd L Walson  1 , Elizabeth R Brown, Phelgona A Otieno, Dorothy A Mbori-Ngacha, Grace Wariua, Elizabeth M Obimbo, Rose K Bosire, Carey Farquhar, Dalton Wamalwa, Grace C John-Stewart
Affiliations

Morbidity among HIV-1-infected mothers in Kenya: prevalence and correlates of illness during 2-year postpartum follow-up

Judd L Walson et al. J Acquir Immune Defic Syndr. .

Abstract

Background: Much of the burden of morbidity affecting women of childbearing age in sub-Saharan Africa occurs in the context of HIV-1 infection. Understanding patterns of illness and determinants of disease in HIV-1-infected mothers may guide effective interventions to improve maternal health in this setting.

Methods: We describe the incidence and cofactors of comorbidities affecting peripartum and postpartum HIV-1-infected women in Kenya. Women were evaluated by clinical examination and standardized questionnaires during pregnancy and for up to 2 years after delivery.

Results: Five hundred thirty-five women were enrolled in the cohort (median CD4 count of 433 cells/mm) and accrued 7736 person-months of follow-up. During 1-year follow-up, the incidence of upper respiratory tract infections was 161 per 100 person-years, incidence of pneumonia was 33 per 100 person-years, incidence of tuberculosis (TB) was 11 per 100 person-years, and incidence of diarrhea was 63 per 100 person-years. Immunosuppression and HIV-1 RNA levels were predictive for pneumonia, oral thrush, and TB but not for diarrhea; CD4 counts <200 cells/mm(3) were associated with pneumonia (relative risk [RR] = 2.87, 95% confidence interval [CI]: 1.71 to 4.83), TB (RR = 7.14, 95% CI: 2.93 to 17.40) and thrush. The risk of diarrhea was significantly associated with crowding (RR = 1.86, 95% CI: 1.19 to 2.92) and breast-feeding (RR = 1.71, 95% CI: 1.19 to 2.44). Less than 10% of women reported hospitalization during 2-year follow-up; mortality risk in the cohort was 1.9% and 4.8% for 1 and 2 years, respectively.

Conclusions: Mothers with HIV-1, although generally healthy, have substantial morbidity as a result of common infections, some of which are predicted by immune status or by socioeconomic factors. Enhanced attention to maternal health is increasingly important as HIV-1-infected mothers transition from programs targeting the prevention of mother-to-child transmission to HIV care clinics.

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Figures

FIGURE 1
FIGURE 1
Trial profile. Over the course of the study period, 12 women initiated ARVs, 32 became pregnant again, 21 died, and 1 became pregnant again and initiated ARVs.
FIGURE 2
FIGURE 2
CD4 cell count decline over 2 years of follow-up. Survival curve for time to CD4 count <200 cells/mm3. The vertical axis is the percentage of patients not yet having met the endpoint, and the horizontal axis is time in months. Overall, most women were not severely immunosuppressed at enrollment; however, over the follow-up period, the number of women meeting criteria for the initiation of ARVs (based on CD4 cell count) increased significantly.
FIGURE 3
FIGURE 3
Individual morbidity increase over the first year of follow-up. The vertical axis shows the number of cases reported per 100 person-years of follow-up. Participants are stratified by CD4 cell count at enrollment. Participants with CD4 counts < 350 cells/mm3 were significantly more likely to develop pneumonia and TB during the follow-up period than those with higher CD4 cell counts. The CD4 cell count did not seem to affect the risk of developing diarrhea.
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References

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