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Observational Study
. 2016 Jul 21:16:103.
doi: 10.1186/s12887-016-0635-5.

HIV-exposed children account for more than half of 24-month mortality in Botswana

Rebecca Zash  1   2   3 , Sajini Souda  4 , Jean Leidner  5 , Heather Ribaudo  6 , Kelebogile Binda  7 , Sikhulile Moyo  7 , Kathleen M Powis  7   6   8 , Chipo Petlo  9 , Mompati Mmalane  7 , Joe Makhema  7 , Max Essex  7   6   10 , Shahin Lockman  7   6   11 , Roger Shapiro  7   6
Affiliations
Observational Study

HIV-exposed children account for more than half of 24-month mortality in Botswana

Rebecca Zash et al. BMC Pediatr. .

Abstract

Background: The contribution of HIV-exposure to childhood mortality in a setting with widespread antiretroviral treatment (ART) availability has not been determined.

Methods: From January 2012 to March 2013, mothers were enrolled within 48 h of delivery at 5 government postpartum wards in Botswana. Participants were followed by phone 1-3 monthly for 24 months. Risk factors for 24-month survival were assessed by Cox proportional hazards modeling.

Results: Three thousand mothers (1499 HIV-infected) and their 3033 children (1515 HIV-exposed) were enrolled. During pregnancy 58 % received three-drug ART, 23 % received zidovudine alone, 11 % received no antiretrovirals (8 % unknown); 2.1 % of children were HIV-infected by 24 months. Vital status at 24 months was known for 3018 (99.5 %) children; 106 (3.5 %) died including 12 (38 %) HIV-infected, 70 (4.7 %) HIV-exposed uninfected, and 24 (1.6 %) HIV-unexposed. Risk factors for mortality were child HIV-infection (aHR 22.6, 95 % CI 10.7, 47.5 %), child HIV-exposure (aHR 2.7, 95 % CI 1.7, 4.5) and maternal death (aHR 8.9, 95 % CI 2.1, 37.1). Replacement feeding predicted mortality when modeled separately from HIV-exposure (aHR 2.3, 95 % CI 1.5, 3.6), but colinearity with HIV-exposure status precluded investigation of its independent effect. Applied at the population level (26 % maternal HIV prevalence), an estimated 52 % of child mortality occurs among HIV-exposed or HIV-infected children.

Conclusions: In a programmatic setting with high maternal HIV prevalence and widespread maternal and child ART availability, HIV-exposed and HIV-infected children still account for most deaths at 24 months. Lack of breastfeeding was a likely contributor to excess mortality among HIV-exposed children.

Keywords: Breastfeeding; Child mortality; HIV-exposed uninfected; HIV-infected children; PMTCT; Sub-Saharan Africa.

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Figures

Fig. 1
Fig. 1
Survival from birth to 24 months among HIV-infected, HIV-exposed uninfected and HIV-unexposed children. Legend: Using the logrank test, there is a significant difference in survival comparing HEU with HUU (p < 0.0001) and comparing HIV-infected with HUU (p < 0.0001)
Fig. 2
Fig. 2
Projected overall childhood mortality in Botswana with varying maternal HIV-infection prevalence and MTCT rate
See this image and copyright information in PMC

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