title: High rates of all-cause and gastroenteritis-related hospitalization morbidity and mortality among HIV-exposed Indian infants.
abstract: BACKGROUND
  HIV-infected and HIV-exposed, uninfected infants experience a high burden of infectious morbidity and mortality. Hospitalization is an important metric for morbidity and is associated with high mortality, yet, little is known about rates and causes of hospitalization among these infants in the first 12 months of life.
  
  
  METHODS
  Using data from a prevention of mother-to-child transmission (PMTCT) trial (India SWEN), where HIV-exposed breastfed infants were given extended nevirapine, we measured 12-month infant all-cause and cause-specific hospitalization rates and hospitalization risk factors.
  
  
  RESULTS
  Among 737 HIV-exposed Indian infants, 93 (13%) were HIV-infected, 15 (16%) were on HAART, and 260 (35%) were hospitalized 381 times by 12 months of life. Fifty-six percent of the hospitalizations were attributed to infections; gastroenteritis was most common accounting for 31% of infectious hospitalizations. Gastrointestinal-related hospitalizations steadily increased over time, peaking around 9 months. The 12-month all-cause hospitalization, gastroenteritis-related hospitalization, and in-hospital mortality rates were 906/1000 PY, 229/1000 PY, and 35/1000 PY respectively among HIV-infected infants and 497/1000 PY, 107/1000 PY, and 3/1000 PY respectively among HIV-exposed, uninfected infants. Advanced maternal age, infant HIV infection, gestational age, and male sex were associated with higher all-cause hospitalization risk while shorter duration of breastfeeding and abrupt weaning were associated with gastroenteritis-related hospitalization.
  
  
  CONCLUSIONS
  HIV-exposed Indian infants experience high rates of all-cause and infectious hospitalization (particularly gastroenteritis) and in-hospital mortality. HIV-infected infants are nearly 2-fold more likely to experience hospitalization and 10-fold more likely to die compared to HIV-exposed, uninfected infants. The combination of scaling up HIV PMTCT programs and implementing proven health measures against infections could significantly reduce hospitalization morbidity and mortality among HIV-exposed Indian infants.
authors.affiliation: Division of Infectious Diseases, Johns Hopkins University School of Medicine, 600 N, Wolfe Street, Baltimore, USA. has9032@med.cornell.edu
authors.forename: Harjot K
authors.initials: HK
authors.lastname: Singh
authors.forename: Nikhil
authors.initials: N
authors.lastname: Gupte
authors.forename: Aarti
authors.initials: A
authors.lastname: Kinikar
authors.forename: Renu
authors.initials: R
authors.lastname: Bharadwaj
authors.forename: Jayagowri
authors.initials: J
authors.lastname: Sastry
authors.forename: Nishi
authors.initials: N
authors.lastname: Suryavanshi
authors.forename: Uma
authors.initials: U
authors.lastname: Nayak
authors.forename: Srikanth
authors.initials: S
authors.lastname: Tripathy
authors.forename: Ramesh
authors.initials: R
authors.lastname: Paranjape
authors.forename: Arun
authors.initials: A
authors.lastname: Jamkar
authors.forename: Robert C
authors.initials: RC
authors.lastname: Bollinger
authors.forename: Amita
authors.initials: A
authors.lastname: Gupta
mesh_terms: D000328:Adult; D005260:Female; D005759:Gastroenteritis / Q000453:epidemiology* / Q000401:mortality* / Q000473:pathology; D015658:HIV Infections / Q000150:complications*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011247:Pregnancy