Journal
AIDS
Volume 27, Issue 5, Pages 749-759Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/QAD.0b013e32835ca29f
Keywords
Africa; HIV; HIV-exposed; infant; morbidity; mortality; pediatric
Categories
Funding
- Prevention Research Centers Special Interest Project of the Centers for Disease Control and Prevention [SIP 1301 U48-CCU409660-09, SIP 26-04 U48-DP00005901, SIP 22-09 U48-DP001944-01]
- National Institute of Allergy and Infectious Diseases
- University of North Carolina Center for AIDS Research [P30-AI50410]
- NIH Fogarty AIDS International Training and Research Program [DHHS/NIH/FIC 2-D43 TW01039-06, R24 TW007988]
- Recovery and Reinvestment Act
- Elizabeth Glaser Pediatric AIDS Foundation
- United Nations Children's Fund
- World Food Program
- Malawi Ministry of Health and Population
- Johnson and Johnson
- US Agency for International Development
- Abbott Laboratories
- GlaxoSmithKline
- Abbott
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Objectives: To evaluate severe (grade 3/4) morbidity and mortality in HIV-exposed, uninfected infants. Design: Secondary data analysis of The Breastfeeding, Antiretrovirals, and Nutrition (BAN) clinical trial. Methods: BAN randomized 2369 mother-infant pairs to maternal, infant, or no extended antiretroviral prophylaxis during breastfeeding. Morbidity outcomes examined were pneumonia/serious febrile illness, diarrhea/growth faltering, and malaria. Infant death was defined as neonatal (<30 days of life), and postneonatal (31 days to 48 weeks of life). Cox proportional hazards models were used to evaluate the effect of covariates on infant morbidity and mortality. Results: The rate of pneumonia/serious febrile illness was highest in the first 12 weeks (0.83/100 person-weeks) before rapidly decreasing; rates of all morbidity outcomes increased after 24 weeks. Rates of pneumonia/serious febrile illness and diarrhea/growth faltering were higher during the rainy season. Prophylactic infant cotrimoxazole significantly decreased the rates of all morbidity outcomes. White blood cell (WBC) count less than 9000/ml at birth was associated with increased diarrhea/growth faltering [adjusted hazard ratio (aHR) 1.73, P = 0.04] and malaria (aHR 2.18, P = 0.02). Low birth weight (2000-2499 g) was associated with neonatal death (aHR 12.3, P< 0.001). Factors associated with postneonatal death included rainy season (aHR 4.24, P = 0.002), infant cotrimoxazole (aHR 0.48, P = 0.03), and low infant WBC count at birth (aHR 2.53, P = 0.02). Conclusion: Infant morbidity rates increased after 24 weeks, when BAN infants weaned. Introduction of prophylactic cotrimoxazole was associated with reduced rates of morbidity and mortality in HIV-exposed uninfected infants. Unexpectedly, a low WBCcount at birth was significantly associated with later infant morbidity and mortality in this cohort. (C) 2013 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins AIDS 2013, 27:749-759
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