title: Morbidity and mortality during the first two years of life among uninfected children born to human immunodeficiency virus type 1-infected women: the women and infants transmission study.
abstract: OBJECTIVE
  We evaluated morbidity and mortality during the first 2 years of life among children born to human immunodeficiency virus-(HIV) type 1-infected women enrolled in the Women and Infants Transmission Study (WITS) during an 11-year period (1990-2001).
  
  
  METHODS
  As part of WITS, evaluations were performed at birth and at 1, 2, 4, 6, 9, 12, 18 and 24 months of age. Growth, hospitalization and the incidence of clinical disease were assessed regularly.
  
  
  RESULTS
  Data regarding 1118 children born to HIV-infected women (955 HIV-uninfected children and 163 HIV-infected children) were analyzed. Fewer changes in the caretaker of the child and fewer in utero exposures to drugs, tobacco and alcohol occurred in the latter periods of the study (all P values for time trend analyses <0.01). The percentages of HIV-uninfected children with poor weight gain (44 of 767; 5.7%), short stature (32 of 703; 4.5%) and wasting (27 of 792; 3.4%) were higher than expected for the general population. Two or more changes in caretaker were associated with all growth deficiencies except wasting, and fetal exposure to tobacco was associated with height abnormalities. Anemia was common and was associated with receipt of zidovudine prophylaxis. Morbidity and mortality decreased during the study period. For the uninfected children, a decrease in class A events (Kaplan-Meier rates: group 1, 22.3%; group 2, 6.8%; group 3, 4.2%; P < 0.001) and class C events and death (Kaplan- Meier event rates: group 1, 2.0%; group 2, 1.7%; group 3, 0.2%; P = 0.062) during the first 2 years of life account for the differences in the curves over time.
  
  
  CONCLUSIONS
  During an 11-year period, morbidity and mortality during the first 24 months of life decreased substantially for children born to HIV-infected women.
authors.affiliation: Baylor College of Medicine, Houston, TX, USA. mepaul@texaschildrenshospital.org
authors.forename: Mary E
authors.initials: ME
authors.lastname: Paul
authors.forename: Caroline J
authors.initials: CJ
authors.lastname: Chantry
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Read
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Frederick
authors.forename: Ming
authors.initials: M
authors.lastname: Lu
authors.forename: Jane
authors.initials: J
authors.lastname: Pitt
authors.forename: Delmyra B
authors.initials: DB
authors.lastname: Turpin
authors.forename: Ellen R
authors.initials: ER
authors.lastname: Cooper
authors.forename: Edward L
authors.initials: EL
authors.lastname: Handelsman
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D005260:Female; D006128:Growth; D015658:HIV Infections / Q000188:drug therapy / Q000401:mortality* / Q000503:physiopathology / Q000635:transmission; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D018445:Infectious Disease Transmission, Vertical; D009017:Morbidity / Q000639:trends; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy* / Q000821:virology; D011297:Prenatal Exposure Delayed Effects; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D019966:Substance-Related Disorders / Q000150:complications
chemical_list: D019380:Anti-HIV Agents; D018894:Reverse Transcriptase Inhibitors