Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Pediatrics
Published in: BMC Pediatrics 1/2016

Open Access 01-12-2016 | Research article

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

Authors: Rebecca Zash, Sajini Souda, Jean Leidner, Heather Ribaudo, Kelebogile Binda, Sikhulile Moyo, Kathleen M. Powis, Chipo Petlo, Mompati Mmalane, Joe Makhema, Max Essex, Shahin Lockman, Roger Shapiro

Published in: BMC Pediatrics | Issue 1/2016

Login to get access

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.
Literature
1.
Newell ML, Brahmbhatt H, Ghys PD. Child mortality and HIV infection in Africa: a review. AIDS. 2004;Suppl 2:S27–34.CrossRef
2.
Chopra M, Daviaud E, Pattinson R, Fonn S, Lawn JE. Saving the lives of South Africa's mothers, babies, and children: can the health system deliver? Lancet. 2009;374:835–46.CrossRefPubMed
3.
4.
5.
Thior I, Lockman S, Smeaton LM, Shapiro RL, Wester C, Heymann SJ, et al. Breastfeeding plus infant zidovudine prophylaxis for 6 months vs formula feeding plus infant zidovudine for 1 month to reduce mother-to-child HIV transmission in Botswana: a randomized trial: the Mashi Study. JAMA. 2006;296:794–805.CrossRefPubMed
6.
7.
Kelly MS, Wirth KE, Steenhoff AP, Cunningham CK, Arscott-Mills T, Boiditswe SC, et al. Treatment failures and excess mortality among HIV-exposed, uninfected children with pneumonia. J Pediatric Infect Dis Soc. 2015;4:e117–26.CrossRefPubMed
8.
Moraleda C, de Deus N, Serna-Bolea C, Renom M, Quinto L, Menendez C, et al. Impact of HIV exposure on health outcomes in HIV-negative infants born to HIV-positive mothers in Sub-Saharan Africa. J Acquir Immune Defic Syndr. 2014;65:182–9.CrossRefPubMed
9.
Landes M, van Lettow M, Chan AK, Mayuni I, Schouten EJ, Bedell RA. Mortality and health outcomes of HIV-exposed and unexposed children in a PMTCT cohort in Malawi. PLoS One. 2012;7:e47337.CrossRefPubMedPubMedCentral
10.
Koyanagi A, Humphrey JH, Ntozini R, Nathoo K, Moulton LH, Iliff P, et al. Morbidity among human immunodeficiency virus-exposed but uninfected, human immunodeficiency virus-infected, and human immunodeficiency virus-unexposed infants in Zimbabwe before availability of highly active antiretroviral therapy. Pediatr Infect Dis J. 2011;30:45–51.CrossRefPubMed
11.
12.
Kuhn L, Kasonde P, Sinkala M, Kanhasa C, Semrau K, Scott N, et al. Does severity of HIV disease in HIV-infected mothers affect mortality and morbidity among their uninfected infants? Clin Infect Dis. 2005;41:1654–61.CrossRefPubMedPubMedCentral
13.
Newell ML, Coovadia H, Cotrina-Borja M, Rollins N, Gaillard P, Dabis F, et al. Mortality of infected and uninfected infants born to HIV-infected mothers in Africa: a pooled analysis. Lancet. 2004;364:1236–43.CrossRefPubMed
14.
Taha TE, Hoover DR, Chen S, Kumwenda NI, Mipando L, Nkanaunena K, et al. Effects of cessation of breastfeeding in HIV-1-exposed, uninfected children in Malawi. Clin Infect Dis. 2011;53:388–95.CrossRefPubMedPubMedCentral
15.
Shapiro RL, Lockman S, Kim S, Smeaton L, Rahkola JT, Thior I, et al. Infant morbidity, mortality, and breast milk immunologic profiles among breast-feeding HIV-infected and HIV-uninfected women in Botswana. J Infect Dis. 2007;196:562–9.CrossRefPubMed
16.
Cournil A, De Vincenzi I, Gaillard P, Carnes C, Fao P, Luchters S, et al. Relationship between mortality and feeding modality among children born to HIV-infected mothers in a research setting: the Kesho Bora Study. AIDS. 2013;27:1621–30.CrossRefPubMed
17.
Fawzy A, Arpadi S, Kankasa C, Sinkala M, Mwiya M, Thea DM, et al. Early weaning increases diarrhea morbidity and mortality among uninfected children born to HIV-infected mothers in Zambia. J Infect Dis. 2011;203:1222–30.CrossRefPubMedPubMedCentral
18.
Rollins NC, Ndirangu J, Bland RM, Coutsoudis A, Coovadia HM, Newell ML. Exclusive breastfeeding, diarrhoeal morbidity and all-cause mortality in infants of HIV-infected and HIV uninfected mothers: an intervention cohort study in KwaZulu Natal, South Africa. PLoS One. 2013;8:e81307.CrossRefPubMedPubMedCentral
19.
20.
Walker N, Hill K, Zhao F. Child mortality estimation: methods used to adjust for bias due to AIDS in estimating trends in under-five mortality. PLoS Med. 2012;9:e1001298.CrossRefPubMedPubMedCentral
21.
22.
23.
Lawlor DA, Mortensen L, Andersen AM. Mechanisms underlying the associations of maternal age with adverse perinatal outcomes: a sibling study of 264 695 Danish women and their firstborn offspring. Int J Epidemiol. 2011;40:1205–14.CrossRefPubMed
24.
25.
26.
Lockman S, Smeaton L, Shapiro R, Thior I, Wester C, Makhema J, et al. Risk factors for and timing of infant mortality among hiv-exposed children in a randomized infant feeding trial in Botswana. Poster presentation, CROI, Boston, Feb 3-8, 2008.
27.
Persaud D, Patel K, Karalius B, Rainwater-Lovett K, Ziemniak C, Ellis A, et al. Influence of age at virologic control on peripheral blood human immunodeficiency virus reservoir size and serostatus in perinatally infected adolescents. JAMA Pediatr. 2014;168:1138–46.CrossRefPubMedPubMedCentral
28.
29.
Chen JY, Ribaudo HJ, Souda S, Parekh N, Ogwu A, Lockman S, et al. Highly active antiretroviral therapy and adverse birth outcomes among HIV-infected women in Botswana. J Infect Dis. 2012;206:1695–705.CrossRefPubMedPubMedCentral
Metadata
Title
HIV-exposed children account for more than half of 24-month mortality in Botswana
Authors
Rebecca Zash
Sajini Souda
Jean Leidner
Heather Ribaudo
Kelebogile Binda
Sikhulile Moyo
Kathleen M. Powis
Chipo Petlo
Mompati Mmalane
Joe Makhema
Max Essex
Shahin Lockman
Roger Shapiro
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Pediatrics / Issue 1/2016
Electronic ISSN: 1471-2431
DOI
https://doi.org/10.1186/s12887-016-0635-5

Other articles of this Issue 1/2016

BMC Pediatrics 1/2016 Go to the issue

Research article

Inequalities in pediatric avoidable hospitalizations between Aboriginal and non-Aboriginal children in Australia: a population data linkage study

Research article

Neonatal outcomes in pregnancies resulting from oocyte donation: a cohort study in Sweden

Research article

The problematic use of Information and Communication Technologies (ICT) in adolescents by the cross sectional JOITIC study

Research article

Parents are poor at labelling wheeze in children: a cross-sectional study

Research article

Availability and affordability of essential medicines for children in the Western part of Ethiopia: implication for access

Research article

Reference curves of birth weight, length, and head circumference for gestational ages in Yogyakarta, Indonesia