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

BMC Pediatrics

Research Article

Rebecca Zash¹  Sikhulile Moyo²  Mompati Mmalane²  Joe Makhema²  Kelebogile Binda²  Roger Shapiro³  Shahin Lockman⁴  Max Essex⁵  Kathleen M. Powis⁶  Jean Leidner⁷  Heather Ribaudo⁸  Chipo Petlo⁹  Sajini Souda^1,10 

[1] Beth Israel Deaconess Medical Center, 110 Francis Street, Suite GB, 02215, Boston, MA, USA;Botswana Harvard AIDS Institute Parternship, Private Bag BO320, Gaborone, Botswana;Harvard T.H. Chan School of Public Health, 651 Huntington Ave, 02115, Boston, MA, USA;Botswana Harvard AIDS Institute Parternship, Private Bag BO320, Gaborone, Botswana;Botswana Harvard AIDS Institute Parternship, Private Bag BO320, Gaborone, Botswana;Harvard T.H. Chan School of Public Health, 651 Huntington Ave, 02115, Boston, MA, USA;Botswana Harvard AIDS Institute Parternship, Private Bag BO320, Gaborone, Botswana;Harvard T.H. Chan School of Public Health, 651 Huntington Ave, 02115, Boston, MA, USA;Brigham and Women’s Hospital, Infectious Diseases Division, 75 Francis Street, 02115, Boston, MA, USA;Botswana Harvard AIDS Institute Parternship, Private Bag BO320, Gaborone, Botswana;Harvard T.H. Chan School of Public Health, 651 Huntington Ave, 02115, Boston, MA, USA;Harvard Medical School, Boston, MA, USA;Botswana Harvard AIDS Institute Parternship, Private Bag BO320, Gaborone, Botswana;Harvard T.H. Chan School of Public Health, 651 Huntington Ave, 02115, Boston, MA, USA;Massachusetts General Hospital, 55 Fruit St, 02114, Boston, MA, USA;Goodtables Data Consulting, Oklahoma, USA;Harvard T.H. Chan School of Public Health, 651 Huntington Ave, 02115, Boston, MA, USA;Ministry of Health, Gaborone, Botswana;University of Botswana, Faculty of Health Sciences, Gaborone, Botswana;

关键词: HIV-exposed uninfected;    Child mortality;    Breastfeeding;    HIV-infected children;    PMTCT;    Sub-Saharan Africa;   

DOI  :  10.1186/s12887-016-0635-5

 received in 2016-01-28, accepted in 2016-07-12,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundThe contribution of HIV-exposure to childhood mortality in a setting with widespread antiretroviral treatment (ART) availability has not been determined.MethodsFrom 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.ResultsThree 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.ConclusionsIn 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.

【 授权许可】

CC BY   
© The Author(s). 2016