Morbidity and mortality among infants born to HIV-infected women in South Africa: implications for child health in resource-limited settings

Abstract

Background: We examined correlates of infant morbidity and mortality within the first 3 months of life among HIV-exposed infants receiving post-exposure antiretroviral prophylaxis in South Africa.

Methods: We conducted a prospective cohort study of 848 mother-child dyads. Multivariable Cox proportional hazards models were used.

Results: The main causes of infant morbidity were gastrointestinal and respiratory infections. Morbidity was higher with infant HIV infection (HR: 2.61; 95% CI: 1.40-4.85; p = 0.002) and maternal plasma viral load (PVL) >100,000 copies ml⁻¹ (HR: 1.87; 95% CI: 1.01-3.48; p = 0.048), and lower with maternal age < 20 years (HR: 0.25; 95% CI: 0.07-0.88; p = 0.031). Mortality was higher with infant HIV infection (HR: 4.10; 95% CI: 1.18-14.31; p = 0.027) and maternal PVL >100,000 copies ml⁻¹ (HR: 6.93; 95% CI: 1.64-29.26; p = 0.008). Infant feeding status did not influence the risk of morbidity nor mortality.

Conclusions: Future interventions that minimize pediatric HIV infection and reduce maternal viremia, which are the main predictors of child health soon after birth, will impact positively on infant health outcomes.

Fig. 1.

Kaplan–Meier: Probability (95% CI) of remaining free from hospitalization within the first 100 days of life according to infant HIV status and mode of infant feeding.The overall log-rank p-value was p < 0.001. The overall log-rank p-value between breast- and formula-fed infants was p = 0.1406. The overall log-rank p-value between HIV-infected and HIV-uninfected infants was p < 0.0001. Among breast-fed infants, the log-rank p-value between HIV-infected and HIV-uninfected infants was p = 0.1730. Among formula-fed infants, the log-rank p-value between HIV-infected and HIV-uninfected infants was p < 0.0001.

Fig. 2.

Kaplan–Meier: probability (95% CI) of remaining alive within the first 100 days of live according to infant HIV status and mode of infant feeding. The overall log-rank p-value was p = 0.0003. The overall log-rank p-value between breast- and formula-fed infants was p = 0.6689. The overall log-rank p-value between HIV-infected and HIV-uninfected infants was p < 0.0001. Among breast-fed infants, the log-rank p-value between HIV-infected and HIV-uninfected infants was p = 0.0047. Among formula-fed infants, the log-rank p-value between HIV-infected and HIV-uninfected infants was p = 0.0005.