title: Morbidity and mortality among a cohort of human immunodeficiency virus type 1-infected and uninfected pregnant women and their infants from Malawi, Zambia, and Tanzania.
abstract: BACKGROUND
  Morbidity and mortality patterns among pregnant women and their infants (before antiretroviral therapy was widely available) determines HIV-1 diagnostic, monitoring, and care interventions.
  
  
  METHODS
  Data from mothers and their infants enrolled in a trial of antibiotics to reduce mother-to-child-transmission of HIV-1 at 4 sub-Saharan African sites were analyzed. Women were enrolled during pregnancy and follow-up continued until the infants reached 12 months of age. We describe maternal and infant morbidity and mortality in a cohort of HIV-1-infected and HIV-1-uninfected mothers. Maternal and infant factors associated with mortality risk in the infants were assessed using Cox proportional hazard modeling.
  
  
  RESULTS
  Among 2292 HIV-1-infected mothers, 166 (7.2%) had a serious adverse event (SAE) and 42 (1.8%) died, whereas no deaths occurred among the 331 HIV-1 uninfected mothers. Four hundred twenty-four (17.8%) of 2383 infants had an SAE and 349 (16.4%) died before the end of follow-up. Infants with early HIV-1 infection (birth to 4-6 weeks) had the highest mortality. Among infants born to HIV-1-infected women, maternal morbidity and mortality (P = 0.0001), baseline CD4 count (P = 0.0002), and baseline plasma HIV-1 RNA concentration (P < 0.0001) were significant predictors of infant mortality in multivariate analyses.
  
  
  CONCLUSIONS
  The high mortality among infants with early HIV-1 infection supports access to HIV-1 diagnostics and appropriate early treatment for all infants of HIV-1-infected mothers. The significant association between stage of maternal HIV-1 infection and infant mortality supports routine CD4 counts at the time of prenatal HIV-1 testing.
authors.affiliation: University of North Carolina Project, Lilongwe, Malawi. hoffmani@med.unc.edu
authors.forename: David
authors.initials: D
authors.lastname: Chilongozi
authors.forename: Lei
authors.initials: L
authors.lastname: Wang
authors.forename: Lillian
authors.initials: L
authors.lastname: Brown
authors.forename: Taha
authors.initials: T
authors.lastname: Taha
authors.forename: Megan
authors.initials: M
authors.lastname: Valentine
authors.forename: Lynda
authors.initials: L
authors.lastname: Emel
authors.forename: Moses
authors.initials: M
authors.lastname: Sinkala
authors.forename: George
authors.initials: G
authors.lastname: Kafulafula
authors.forename: Ramadhani A
authors.initials: RA
authors.lastname: Noor
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Read
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Brown
authors.forename: Robert L
authors.initials: RL
authors.lastname: Goldenberg
authors.forename: Irving
authors.initials: I
authors.lastname: Hoffman
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000401:mortality* / Q000517:prevention & control / Q000635:transmission; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D008137:Longitudinal Studies; D008295:Malawi; D015999:Multivariate Analysis; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology* / Q000401:mortality*; D037841:Pregnant People; D016016:Proportional Hazards Models; D012307:Risk Factors; D016019:Survival Analysis; D013636:Tanzania; D013997:Time Factors; D019562:Viral Load; D015024:Zambia
chemical_list: D000900:Anti-Bacterial Agents