title: Does severity of HIV disease in HIV-infected mothers affect mortality and morbidity among their uninfected infants?
abstract: 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/microL 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Gertrude H. Sergievsky Center, Mailman School of Public Health, Columbia University, New York, NY, USA. lk24@columbia.edu
authors.forename: Louise
authors.initials: L
authors.lastname: Kuhn
authors.forename: Prisca
authors.initials: P
authors.lastname: Kasonde
authors.forename: Moses
authors.initials: M
authors.lastname: Sinkala
authors.forename: Chipepo
authors.initials: C
authors.lastname: Kankasa
authors.forename: Katherine
authors.initials: K
authors.lastname: Semrau
authors.forename: Nancy
authors.initials: N
authors.lastname: Scott
authors.forename: Wei-Yann
authors.initials: WY
authors.lastname: Tsai
authors.forename: Sten H
authors.initials: SH
authors.lastname: Vermund
authors.forename: Grace M
authors.initials: GM
authors.lastname: Aldrovandi
authors.forename: Donald M
authors.initials: DM
authors.lastname: Thea
mesh_terms: D000375:Aging; D001724:Birth Weight; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000276:immunology* / Q000503:physiopathology*; D006760:Hospitalization; D006801:Humans; D007108:Immune Tolerance; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D009035:Mothers; D012307:Risk Factors; D015024:Zambia / Q000453:epidemiology