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

BMC Pediatr 2016 07 21;16:103. Epub 2016 Jul 21.

Botswana Harvard AIDS Institute Parternship, Private Bag BO320, Gaborone, Botswana.

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.

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Source
http://dx.doi.org/10.1186/s12887-016-0635-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4955224PMC
July 2016
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References

(Supplied by CrossRef)

ML Newell et al.
AIDS 2004

M Chopra et al.
Lancet 2009

I Thior et al.
JAMA 2006

MS Kelly et al.
J Pediatric Infect Dis Soc 2015

C Moraleda et al.
J Acquir Immune Defic Syndr 2014

M Landes et al.
PLoS One 2012

A Koyanagi et al.
Pediatr Infect Dis J 2011

S Filteau et al.
Trop Med Int Health 2009

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