title: Children who acquire HIV infection perinatally are at higher risk of early death than those acquiring infection through breastmilk: a meta-analysis.
abstract: BACKGROUND
  Assumptions about survival of HIV-infected children in Africa without antiretroviral therapy need to be updated to inform ongoing UNAIDS modelling of paediatric HIV epidemics among children. Improved estimates of infant survival by timing of HIV-infection (perinatally or postnatally) are thus needed.
  
  
  RESULTS
  A pooled analysis was conducted of individual data of all available intervention cohorts and randomized trials on prevention of HIV mother-to-child transmission in Africa. Studies were right-censored at the time of infant antiretroviral initiation. Overall mortality rate per 1000 child-years of follow-up was calculated by selected maternal and infant characteristics. The Kaplan-Meier method was used to estimate survival curves by child's HIV infection status and timing of HIV infection. Individual data from 12 studies were pooled, with 12,112 children of HIV-infected women. Mortality rates per 1,000 child-years follow-up were 39.3 and 381.6 for HIV-uninfected and infected children respectively. One year after acquisition of HIV infection, an estimated 26% postnatally and 52% perinatally infected children would have died; and 4% uninfected children by age 1 year. Mortality was independently associated with maternal death (adjusted hazard ratio 2.2, 95%CI 1.6-3.0), maternal CD4<350 cells/ml (1.4, 1.1-1.7), postnatal (3.1, 2.1-4.1) or peri-partum HIV-infection (12.4, 10.1-15.3).
  
  
  CONCLUSIONS
  These results update previous work and inform future UNAIDS modelling by providing survival estimates for HIV-infected untreated African children by timing of infection. We highlight the urgent need for the prevention of peri-partum and postnatal transmission and timely assessment of HIV infection in infants to initiate antiretroviral care and support for HIV-infected children.
authors.affiliation: Institut National de la Santé et de la Recherche Médicale, Unité 897, Centre de Recherche Epidémiologie et Biostatistique, Bordeaux, France. Renaud.Becquet@isped.u-bordeaux2.fr
authors.forename: Renaud
authors.initials: R
authors.lastname: Becquet
authors.forename: Milly
authors.initials: M
authors.lastname: Marston
authors.forename: François
authors.initials: F
authors.lastname: Dabis
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Moulton
authors.forename: Glenda
authors.initials: G
authors.lastname: Gray
authors.forename: Hoosen M
authors.initials: HM
authors.lastname: Coovadia
authors.forename: Max
authors.initials: M
authors.lastname: Essex
authors.forename: Didier K
authors.initials: DK
authors.lastname: Ekouevi
authors.forename: Debra
authors.initials: D
authors.lastname: Jackson
authors.forename: Anna
authors.initials: A
authors.lastname: Coutsoudis
authors.forename: Charles
authors.initials: C
authors.lastname: Kilewo
authors.forename: Valériane
authors.initials: V
authors.lastname: Leroy
authors.forename: Stefan Z
authors.initials: SZ
authors.lastname: Wiktor
authors.forename: Ruth
authors.initials: R
authors.lastname: Nduati
authors.forename: Philippe
authors.initials: P
authors.lastname: Msellati
authors.forename: Basia
authors.initials: B
authors.lastname: Zaba
authors.forename: Peter D
authors.initials: PD
authors.lastname: Ghys
authors.forename: Marie-Louise
authors.initials: ML
authors.lastname: Newell
mesh_terms: D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D001942:Breast Feeding / Q000009:adverse effects; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000401:mortality* / Q000635:transmission*; D006679:HIV Seropositivity / Q000635:transmission; D015497:HIV-1 / Q000378:metabolism; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D008297:Male; D008895:Milk, Human / Q000821:virology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious; D015996:Survival Rate
chemical_list: D044966:Anti-Retroviral Agents