Mortality of infected and uninfected infants born to HIV-infected mothers in Africa: a pooled analysis
HIV contributes substantially to child mortality, but factors underlying these deaths are inadequately described. With individual data from seven randomised mother-to-child transmission (MTCT) intervention trials, we estimate mortality in African children born to HIV-infected mothers and analyse sel...
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| Veröffentlicht in: | The Lancet (British edition) 2004-10, Vol.364 (9441), p.1236-1243 |
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| creator | Newell, Marie-Louise Coovadia, Hoosen Cortina-Borja, Marjo Rollins, Nigel Gaillard, Philippe Dabis, Francois |
| description | HIV contributes substantially to child mortality, but factors underlying these deaths are inadequately described. With individual data from seven randomised mother-to-child transmission (MTCT) intervention trials, we estimate mortality in African children born to HIV-infected mothers and analyse selected risk factors.
Early HIV infection was defined as a positive HIV-PCR test before 4 weeks of age; and late infection by a negative PCR test at or after 4 weeks of age, followed by a positive test. Mortality rate was expressed per 1000 child-years. We investigated the effect of maternal health, infant HIV infection, feeding practices, and age at acquisition of infection on mortality assessed with Cox proportional hazards models, and allowed for random effects for trials grouped geographically.
378 (11%) of 3468 children died. By age 1 year, an estimated 35·2% infected and 4·9% uninfected children will have died; by 2 years of age, 52·5% and 7·6% will have died, respectively. Mortality varied by geographical region, and was associated with maternal death (adjusted odds ratio 2·27, 95% CI 1·62–3·19), CD4+ cell counts |
| doi_str_mv | 10.1016/S0140-6736(04)17140-7 |
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Early HIV infection was defined as a positive HIV-PCR test before 4 weeks of age; and late infection by a negative PCR test at or after 4 weeks of age, followed by a positive test. Mortality rate was expressed per 1000 child-years. We investigated the effect of maternal health, infant HIV infection, feeding practices, and age at acquisition of infection on mortality assessed with Cox proportional hazards models, and allowed for random effects for trials grouped geographically.
378 (11%) of 3468 children died. By age 1 year, an estimated 35·2% infected and 4·9% uninfected children will have died; by 2 years of age, 52·5% and 7·6% will have died, respectively. Mortality varied by geographical region, and was associated with maternal death (adjusted odds ratio 2·27, 95% CI 1·62–3·19), CD4+ cell counts <200 per μL (1·91, 1·39–2·62), and infant HIV infection (8·16, 6·43–10·33). Mortality was not associated with either ever breastfeeding and never breastfeeding in either infected or uninfected children. In infected children, mortality was significantly lower for those with late infection than those with early infection (0·52, 0·39–0·70). This effect was also seen in analyses of survival from the age at infection (0·74, 0·55–0·99).
These findings highlight the necessity for timely antiretroviral care, for support for HIV-infected women and children in developing countries, and for assessment of prophylactic programmes to prevent MTCT, including child mortality and infection averted.</description><identifier>ISSN: 0140-6736</identifier><identifier>EISSN: 1474-547X</identifier><identifier>DOI: 10.1016/S0140-6736(04)17140-7</identifier><identifier>PMID: 15464184</identifier><identifier>CODEN: LANCAO</identifier><language>eng</language><publisher>London: Elsevier Ltd</publisher><subject>Africa South of the Sahara - epidemiology ; Antiretroviral agents ; Babies ; Biological and medical sciences ; Breast Feeding ; Developing countries ; Disease transmission ; Female ; General aspects ; HIV ; HIV Infections - congenital ; HIV Infections - mortality ; HIV Infections - transmission ; Human immunodeficiency virus ; Human viral diseases ; Humans ; Infant ; Infant Mortality ; Infant, Newborn ; Infants ; Infections ; Infectious Disease Transmission, Vertical ; Infectious diseases ; LDCs ; Medical sciences ; Mortality ; Pregnancy ; Pregnancy Complications, Infectious ; Risk Factors ; Survival Rate ; Viral diseases ; Viral diseases of the lymphoid tissue and the blood. Aids</subject><ispartof>The Lancet (British edition), 2004-10, Vol.364 (9441), p.1236-1243</ispartof><rights>2004 Elsevier Ltd</rights><rights>2004 INIST-CNRS</rights><rights>Copyright Lancet Ltd. Oct 2-Oct 8, 2004</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c536t-ac5a6275888df135e9fd4ea38a806bde95810b2de6658f0c6c2e116d3ea6b38b3</citedby><cites>FETCH-LOGICAL-c536t-ac5a6275888df135e9fd4ea38a806bde95810b2de6658f0c6c2e116d3ea6b38b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0140673604171407$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=16157045$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15464184$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Newell, Marie-Louise</creatorcontrib><creatorcontrib>Coovadia, Hoosen</creatorcontrib><creatorcontrib>Cortina-Borja, Marjo</creatorcontrib><creatorcontrib>Rollins, Nigel</creatorcontrib><creatorcontrib>Gaillard, Philippe</creatorcontrib><creatorcontrib>Dabis, Francois</creatorcontrib><creatorcontrib>for the Ghent International AIDS Society (IAS) working group on HIV infection in women and children</creatorcontrib><creatorcontrib>Ghent International AIDS Society (IAS) Working Group on HIV Infection in Women and Children</creatorcontrib><title>Mortality of infected and uninfected infants born to HIV-infected mothers in Africa: a pooled analysis</title><title>The Lancet (British edition)</title><addtitle>Lancet</addtitle><description>HIV contributes substantially to child mortality, but factors underlying these deaths are inadequately described. With individual data from seven randomised mother-to-child transmission (MTCT) intervention trials, we estimate mortality in African children born to HIV-infected mothers and analyse selected risk factors.
Early HIV infection was defined as a positive HIV-PCR test before 4 weeks of age; and late infection by a negative PCR test at or after 4 weeks of age, followed by a positive test. Mortality rate was expressed per 1000 child-years. We investigated the effect of maternal health, infant HIV infection, feeding practices, and age at acquisition of infection on mortality assessed with Cox proportional hazards models, and allowed for random effects for trials grouped geographically.
378 (11%) of 3468 children died. By age 1 year, an estimated 35·2% infected and 4·9% uninfected children will have died; by 2 years of age, 52·5% and 7·6% will have died, respectively. Mortality varied by geographical region, and was associated with maternal death (adjusted odds ratio 2·27, 95% CI 1·62–3·19), CD4+ cell counts <200 per μL (1·91, 1·39–2·62), and infant HIV infection (8·16, 6·43–10·33). Mortality was not associated with either ever breastfeeding and never breastfeeding in either infected or uninfected children. In infected children, mortality was significantly lower for those with late infection than those with early infection (0·52, 0·39–0·70). This effect was also seen in analyses of survival from the age at infection (0·74, 0·55–0·99).
These findings highlight the necessity for timely antiretroviral care, for support for HIV-infected women and children in developing countries, and for assessment of prophylactic programmes to prevent MTCT, including child mortality and infection averted.</description><subject>Africa South of the Sahara - epidemiology</subject><subject>Antiretroviral agents</subject><subject>Babies</subject><subject>Biological and medical sciences</subject><subject>Breast Feeding</subject><subject>Developing countries</subject><subject>Disease transmission</subject><subject>Female</subject><subject>General aspects</subject><subject>HIV</subject><subject>HIV Infections - congenital</subject><subject>HIV Infections - mortality</subject><subject>HIV Infections - transmission</subject><subject>Human immunodeficiency virus</subject><subject>Human viral diseases</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant Mortality</subject><subject>Infant, Newborn</subject><subject>Infants</subject><subject>Infections</subject><subject>Infectious Disease Transmission, Vertical</subject><subject>Infectious diseases</subject><subject>LDCs</subject><subject>Medical sciences</subject><subject>Mortality</subject><subject>Pregnancy</subject><subject>Pregnancy Complications, Infectious</subject><subject>Risk Factors</subject><subject>Survival Rate</subject><subject>Viral diseases</subject><subject>Viral diseases of the lymphoid tissue and the blood. 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Academic</collection><jtitle>The Lancet (British edition)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Newell, Marie-Louise</au><au>Coovadia, Hoosen</au><au>Cortina-Borja, Marjo</au><au>Rollins, Nigel</au><au>Gaillard, Philippe</au><au>Dabis, Francois</au><aucorp>for the Ghent International AIDS Society (IAS) working group on HIV infection in women and children</aucorp><aucorp>Ghent International AIDS Society (IAS) Working Group on HIV Infection in Women and Children</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Mortality of infected and uninfected infants born to HIV-infected mothers in Africa: a pooled analysis</atitle><jtitle>The Lancet (British edition)</jtitle><addtitle>Lancet</addtitle><date>2004-10-02</date><risdate>2004</risdate><volume>364</volume><issue>9441</issue><spage>1236</spage><epage>1243</epage><pages>1236-1243</pages><issn>0140-6736</issn><eissn>1474-547X</eissn><coden>LANCAO</coden><abstract>HIV contributes substantially to child mortality, but factors underlying these deaths are inadequately described. With individual data from seven randomised mother-to-child transmission (MTCT) intervention trials, we estimate mortality in African children born to HIV-infected mothers and analyse selected risk factors.
Early HIV infection was defined as a positive HIV-PCR test before 4 weeks of age; and late infection by a negative PCR test at or after 4 weeks of age, followed by a positive test. Mortality rate was expressed per 1000 child-years. We investigated the effect of maternal health, infant HIV infection, feeding practices, and age at acquisition of infection on mortality assessed with Cox proportional hazards models, and allowed for random effects for trials grouped geographically.
378 (11%) of 3468 children died. By age 1 year, an estimated 35·2% infected and 4·9% uninfected children will have died; by 2 years of age, 52·5% and 7·6% will have died, respectively. Mortality varied by geographical region, and was associated with maternal death (adjusted odds ratio 2·27, 95% CI 1·62–3·19), CD4+ cell counts <200 per μL (1·91, 1·39–2·62), and infant HIV infection (8·16, 6·43–10·33). Mortality was not associated with either ever breastfeeding and never breastfeeding in either infected or uninfected children. In infected children, mortality was significantly lower for those with late infection than those with early infection (0·52, 0·39–0·70). This effect was also seen in analyses of survival from the age at infection (0·74, 0·55–0·99).
These findings highlight the necessity for timely antiretroviral care, for support for HIV-infected women and children in developing countries, and for assessment of prophylactic programmes to prevent MTCT, including child mortality and infection averted.</abstract><cop>London</cop><pub>Elsevier Ltd</pub><pmid>15464184</pmid><doi>10.1016/S0140-6736(04)17140-7</doi><tpages>8</tpages></addata></record> |
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| ispartof | The Lancet (British edition), 2004-10, Vol.364 (9441), p.1236-1243 |
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| subjects | Africa South of the Sahara - epidemiology Antiretroviral agents Babies Biological and medical sciences Breast Feeding Developing countries Disease transmission Female General aspects HIV HIV Infections - congenital HIV Infections - mortality HIV Infections - transmission Human immunodeficiency virus Human viral diseases Humans Infant Infant Mortality Infant, Newborn Infants Infections Infectious Disease Transmission, Vertical Infectious diseases LDCs Medical sciences Mortality Pregnancy Pregnancy Complications, Infectious Risk Factors Survival Rate Viral diseases Viral diseases of the lymphoid tissue and the blood. Aids |
| title | Mortality of infected and uninfected infants born to HIV-infected mothers in Africa: a pooled analysis |
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