C-reactive protein independently predicts HIV-related outcomes among women and children in a resource-poor setting.
OBJECTIVE
To evaluate C-reactive protein (CRP) as a predictor of HIV-related outcomes among women and children in a resource-poor setting.


METHODS
We measured serum CRP concentration among 606 HIV-infected women, all of whom were not taking highly-active antiretroviral therapy, 3 to 11 months after they gave birth, and assessed relationships of CRP to HIV-related endpoints, including maternal disease progression, mother-to-child transmission of HIV, and maternal and child mortality.


METHODS
We used Cox proportional hazards and regression models adjusted for age, sociodemographic characteristics, anthropometric measurements, hemoglobin, CD4 cell count, HIV viral load, and, for child outcomes, breastfeeding status.


RESULTS
Ninety-four women had a high CRP concentration (> 10 mg/l). During the follow-up, 56 women progressed to WHO stage 4 and 188 died, and a high maternal CRP concentration was associated with a 2.26-fold [95% confidence interval (CI), 1.64-3.12] greater risk of progression to stage 4 or death. Among children, 174 acquired HIV and 116 died by age 2 years, and a high maternal CRP concentration was associated with a 3.03-fold (95% CI, 1.85-4.96) greater risk of child mortality. In multivariate analyses among adults, a high maternal CRP concentration was associated with a 1.55-fold (95% CI, 1.08-2.23) greater risk of progression to stage 4 or death. A maternal CRP concentration was not significantly associated with mother-to-child transmission of HIV.


CONCLUSIONS
A high maternal CRP concentration independently predicts HIV disease progression, maternal mortality, and child mortality in a resource-poor setting. C-reactive protein may be an important and inexpensive prognostic indicator for HIV-infected women and their children.
Drain
Paul K
PK
School of Medicine, University of Washington, Seattle, Washington, USA. pkdrain@stanford.edu
Kupka
Roland
R
Msamanga
Gernard I
GI
Urassa
Willy
W
Mugusi
Ferdinand
F
Fawzi
Wafaie W
WW
D002097:C-Reactive Protein / Q000032:analysis*; D046688:Child Mortality; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000097:blood* / Q000175:diagnosis / Q000401:mortality / Q000635:transmission; D015497:HIV-1; D006295:Health Resources; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D018445:Infectious Disease Transmission, Vertical; D008428:Maternal Mortality; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000097:blood* / Q000175:diagnosis / Q000401:mortality; D011379:Prognosis; D013636:Tanzania / Q000453:epidemiology
D002097:C-Reactive Protein