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. 2017 Feb;36(2):e38-e44.
doi: 10.1097/INF.0000000000001391.

A Prospective Cohort Study of Common Childhood Infections in South African HIV-exposed Uninfected and HIV-unexposed Infants

Amy L Slogrove  1 , Monika M Esser, Mark F Cotton, David P Speert, Tobias R Kollmann, Joel Singer, Julie A Bettinger
Affiliations

A Prospective Cohort Study of Common Childhood Infections in South African HIV-exposed Uninfected and HIV-unexposed Infants

Amy L Slogrove et al. Pediatr Infect Dis J. 2017 Feb.

Abstract

Background: Much evidence of HIV-exposed uninfected (HEU) infant infectious morbidity predates availability of maternal combination antiretroviral therapy and does not control for universal risk factors (preterm birth, low birth weight, suboptimal breastfeeding and poverty).

Methods: This prospective cohort study identified HIV-infected and HIV-uninfected mothers and their newborns from South African community midwife unit. The primary outcome, infectious cause hospitalization or death before 6 months of age, was compared between HEU and HIV-unexposed (HU) infants and classified for type and severity using validated study-specific case definitions. Adjusted odds ratios (aORs) were calculated by logistic regression including stratified analyses conditioned on breastfeeding.

Results: One hundred and seventy-six (94 HEU and 82 HU) mother-infant pairs were analyzed. HIV-infected mothers were older (median, 27.8 vs. 24.7 years; P < 0.01) and HU infants more often breastfed (81/82 vs. 35/94; P < 0.001). Groups were similar for maternal education, antenatal course, household characteristics, birth weight, gestational age and immunizations. The primary outcome occurred in 17 (18%) HEU and 10 (12%) HU infants [aOR, 1.45; 95% confidence interval (CI): 0.44-4.55]. In stratified analysis restricted to breastfed infants, the aOR for hospitalization due to very severe infection or death was 4.2 (95% CI: 1.00-19.2; P = 0.05) for HEU infants. Hospitalization for diarrhea was more common in HEU than HU infants [8/94 (8.5%) vs. 1/82 (1.2%); P = 0.04].

Conclusion: The difference between HEU and HU infants in the probability of infectious cause hospitalization or death in the first 6 months of life was not significant. However, among breastfed infants, severe infectious morbidity occurred more often in HEU than HU infants.

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Conflict of interest statement

This work was supported by a Major Thematic Grant from the Peter Wall Institute for Advanced Studies, University of British Columbia (grant number: F0906208) and the Canadian Institutes of Health Research Canada-Hope programme (grant number: CH1-106949). Dr. Slogrove was supported by research fellowships from the Canadian Institutes of Health Research Canada-Hope Programme, The Canadian HIV Trials Network International Fellowship and the South African National Health Scholarship Programme. Dr. Bettinger is a Michael Smith Foundation for Health Research Scholar. The authors have no conflicts of interest to disclose.

Figures

FIGURE 1.
FIGURE 1.
Infant age at time of primary outcome event.
See this image and copyright information in PMC

References

    1. South African National Department of Health. The 2011 National Antenatal Sentinel HIV and Syphilis Prevalence Survey. 2012. [Cited October 17, 2015]. Available at: http://sanac.org.za/resources/cat_view/7-publications/9-reports.
    1. Goga AE, Dinh TH, Jackson DJ. Evaluation of the Effectiveness of the National Prevention of Mother-to-Child Transmission (PMTCT) Programme on Infant HIV Measured at Six Weeks Postpartum in South Africa, 2010. 2012. [Cited October 17, 2015]. Available at: http://sanac.org.za/resources/cat_view/7-publications/9-reports.
    1. Statistics South Africa. Recorded live Births 2011. Pretoria, South Africa: Statistics South Africa; 2012. Aug 16, [Cited October 17, 2015]. Available at: http://www.statssa.gov.za/publications/P0305/P03052011.pdf.
    1. Thea DM, St Louis ME, Atido U, et al. A prospective study of diarrhea and HIV-1 infection among 429 Zairian infants. N Engl J Med. 1993;329:1696–1702. - PubMed
    1. Spira R, Lepage P, Msellati P, et al. Natural history of human immunodeficiency virus type 1 infection in children: a five-year prospective study in Rwanda. Pediatrics. 1999;104:1–9. - PubMed

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