Maternal disease stage and child undernutrition in relation to mortality among children born to HIV-infected women in Tanzania.
OBJECTIVE
To examine whether maternal HIV disease stage during pregnancy and child malnutrition are associated with child mortality.


METHODS
Prospective cohort study in Tanzania.


METHODS
Indicators of disease stage were assessed for 939 HIV-infected women during pregnancy and at delivery, and children's anthropometric status was obtained at scheduled monthly clinic visits after delivery. Children were followed up for survival status until 24 months after birth.


RESULTS
Advanced maternal HIV disease during pregnancy (CD4 count <350 vs. >or=350 cells/mm) was associated with increased risk of child mortality through 24 months of age (hazard ratio [HR] = 1.74, 95% confidence interval [CI]: 1.32 to 2.30). CD4 count <350 cells/mm was also associated with an increased risk of death among children who remained HIV-negative during follow-up (HR = 2.00, 95% CI: 1.36 to 2.94). Low maternal hemoglobin concentration and child undernutrition were related to an increased risk of mortality in this cohort of children.


CONCLUSIONS
Low maternal CD4 cell count during pregnancy is related to increased risk of mortality in children born to HIV-infected women. Care and treatment for HIV disease, including highly active antiretroviral therapy to pregnant women, could improve child survival. Prevention and treatment of undernutrition in children remain critical interventions in settings with high HIV prevalence.
Chatterjee
Anirban
A
Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA. mina@hsph.harvard.edu
Bosch
Ronald J
RJ
Hunter
David J
DJ
Fataki
Maulidi R
MR
Msamanga
Gernard I
GI
Fawzi
Wafaie W
WW
D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000151:congenital / Q000401:mortality*; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D044342:Malnutrition / Q000150:complications*; D009035:Mothers; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious; D011446:Prospective Studies; D012307:Risk Factors; D013636:Tanzania / Q000453:epidemiology
D006454:Hemoglobins