Survival of infants in the context of prevention of mother to child HIV transmission in South Africa.
OBJECTIVE
We sought to study the survival of newborn children according to HIV status of the mother, that of the child and the timing of infection.


METHODS
This is a prospective cohort study of 883 mothers (665 HIV-positive and 218 HIV-negative) and their infants. Data were collected using semi-structured questionnaires during home visits between the antenatal period and 36 weeks post-delivery. Infant HIV status was determined at 3, 24 and 36 weeks by HIV DNA PCR.


RESULTS
The majority (81.3%) of infected infants who died were infected by 3 weeks of age. Of the HIV-exposed infants who died, 19 (28.4%) died before 6 weeks and 38 (56.7%) died by 12 weeks. The hazard ratio (HR) of mortality at 36 weeks of age in HIV-infected infants compared with exposed but negative infants was 8.9 (95% CI: 6.7-11.8). There was no significant difference in 36 week survival rates between HIV-non-exposed and HIV-exposed but negative infants (HR: 0.7; 95% CI: 0.3-1.5). The infant being HIV-positive at age 3 weeks (HR: 32 95% CI: 14.0-73.1) and rural site (HR: 4.4 95% CI: 1.2-23.4) were the two independent risk factors for infant death amongst HIV-exposed infants.


CONCLUSIONS
The prognosis for infants with early HIV infection was very poor in this cohort. A greater focus on prevention of early infection, earlier screening for HIV infection and access to antiretrovirals for eligible infants is recommended.
Chopra
M
M
.Health Systems Research Unit, Medical Research Council, Tygerberg, Western Cape, South Africa.Department of International Maternal & Child Health Uppsala University, Uppsala, Sweden.School of Public Health, University of the Western Cape, Western Cape, South Africa.Department of Paediatrics and Child Health, University of Limpopo, MEDUNSA Campus, South Africa.
Doherty
T
T
.Health Systems Research Unit, Medical Research Council, Tygerberg, Western Cape, South Africa.Department of International Maternal & Child Health Uppsala University, Uppsala, Sweden.School of Public Health, University of the Western Cape, Western Cape, South Africa.Department of Paediatrics and Child Health, University of Limpopo, MEDUNSA Campus, South Africa.
Goga
A
A
.Health Systems Research Unit, Medical Research Council, Tygerberg, Western Cape, South Africa.Department of International Maternal & Child Health Uppsala University, Uppsala, Sweden.School of Public Health, University of the Western Cape, Western Cape, South Africa.Department of Paediatrics and Child Health, University of Limpopo, MEDUNSA Campus, South Africa.
Jackson
D
D
.Health Systems Research Unit, Medical Research Council, Tygerberg, Western Cape, South Africa.Department of International Maternal & Child Health Uppsala University, Uppsala, Sweden.School of Public Health, University of the Western Cape, Western Cape, South Africa.Department of Paediatrics and Child Health, University of Limpopo, MEDUNSA Campus, South Africa.
Persson
L A
LA
.Health Systems Research Unit, Medical Research Council, Tygerberg, Western Cape, South Africa.Department of International Maternal & Child Health Uppsala University, Uppsala, Sweden.School of Public Health, University of the Western Cape, Western Cape, South Africa.Department of Paediatrics and Child Health, University of Limpopo, MEDUNSA Campus, South Africa.
D004279:DNA, Viral; D005260:Female; D015658:HIV Infections / Q000401:mortality / Q000517:prevention & control / Q000635:transmission*; D015497:HIV-1; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D053208:Kaplan-Meier Estimate; D008297:Male; D016133:Polymerase Chain Reaction; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology; D011795:Surveys and Questionnaires
D004279:DNA, Viral