Journal Article

Does Severity of HIV Disease in HIV-Infected Mothers Affect Mortality and Morbidity among Their Uninfected Infants?

Louise Kuhn, Prisca Kasonde, Moses Sinkala, Chipepo Kankasa, Katherine Semrau, Nancy Scott, Wei-Yann Tsai, Sten H. Vermund, Grace M. Aldrovandi and Donald M. Thea

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 41, issue 11, pages 1654-1661
Published in print December 2005 | ISSN: 1058-4838
Published online December 2005 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/498029
Does Severity of HIV Disease in HIV-Infected Mothers Affect Mortality and Morbidity among Their Uninfected Infants?

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Background. Rates of perinatal human immunodeficiency virus (HIV) transmission are higher among HIV-infected mothers with more advanced disease, but effects of maternal disease on HIV-uninfected offspring are unclear. We investigated the hypothesis that the severity of HIV disease and immune dysfunction among mothers is associated with increased morbidity and mortality among their uninfected infants.

Methods. In a birth cohort of 620 HIV-uninfected infants born to HIV-infected mothers in Lusaka, Zambia, we investigated associations between markers of more advanced maternal HIV disease and child mortality, hospital admissions, and infant weight through 4 months of age.

Results. Mortality in the cohort of uninfected infants was 4.6% (95% confidence interval [CI], 2.8–6.3) through 4 months of age. Infants of mothers with CD4+ T cell counts of <350 cells/µL were more likely to die (hazard ratio [HR], 2.87; 95% CI, 1.03–8.03) and were more likely to be hospitalized (HR, 2.28; 95% CI, 1.17–4.45), after adjusting for other factors, including maternal death and low birth weight. The most common cause of infant death and hospitalization was pneumonia and/or sepsis. A maternal viral load of>100,000 copies/mL was associated with significantly lower child weight through 4 months of age.

Conclusion. Children born to HIV-infected mothers with advanced disease who escaped perinatal or early breastfeeding-related HIV infection are nonetheless at high risk of mortality and morbidity during the first few months of life. HIV-related immunosuppression appears to have adverse consequences for the health of infants, in addition to risks of vertical transmission.

Journal Article.  4520 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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