Journal article
Health outcomes of HIV-exposed uninfected African infants
AIDS (London), Vol.27(5), pp.749-759
03/13/2013
DOI: 10.1097/QAD.0b013e32835ca29f
PMCID: PMC4493890
PMID: 23719347
Abstract
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
Details
- Title: Subtitle
- Health outcomes of HIV-exposed uninfected African infants
- Creators
- Athena P. Kourtis - Centers for Disease Control and PreventionJeffrey Wiener - Centers for Disease Control and PreventionDumbani Kayira - Univ North Carolina Project, Lilongwe, MalawiCharles Chasela - Univ North Carolina Project, Lilongwe, MalawiSascha R. Ellington - Centers for Disease Control and PreventionLisa Hyde - Univ North Carolina Project, Lilongwe, MalawiMina Hosseinipour - University of North Carolina at Chapel HillCharles van der Horst - University of North Carolina at Chapel HillDenise J. Jamieson - Centers for Disease Control and Prevention
- Resource Type
- Journal article
- Publication Details
- AIDS (London), Vol.27(5), pp.749-759
- DOI
- 10.1097/QAD.0b013e32835ca29f
- PMID
- 23719347
- PMCID
- PMC4493890
- NLM abbreviation
- AIDS
- ISSN
- 0269-9370
- eISSN
- 1473-5571
- Publisher
- Lippincott Williams & Wilkins
- Number of pages
- 11
- Grant note
- U48DP000059 / NATIONAL CENTER FOR CHRONIC DISEASE PREV AND HEALTH PROMO; United States Department of Health & Human Services; Centers for Disease Control & Prevention - USA US Agency for International Development; United States Agency for International Development (USAID) Elizabeth Glaser Pediatric AIDS Foundation D43TW001039 / FOGARTY INTERNATIONAL CENTER; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH Fogarty International Center (FIC) Johnson and Johnson; Johnson & Johnson; Johnson & Johnson USA SIP 1301 U48-CCU409660-09; SIP 26-04 U48-DP00005901; SIP 22-09 U48-DP001944-01 / Prevention Research Centers Special Interest Project of the Centers for Disease Control and Prevention Recovery and Reinvestment Act DHHS/NIH/FIC 2-D43 TW01039-06; R24 TW007988 / NIH Fogarty AIDS International Training and Research Program P30AI050410 / NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Allergy & Infectious Diseases (NIAID) GlaxoSmithKline Abbott Laboratories P30-AI50410 / University of North Carolina Center for AIDS Research World Food Program National Institute of Allergy and Infectious Diseases; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Allergy & Infectious Diseases (NIAID) Malawi Ministry of Health and Population United Nations Children's Fund Abbott; Abbott Laboratories
- Language
- English
- Date published
- 03/13/2013
- Academic Unit
- Obstetrics and Gynecology; VPMA - Administration
- Record Identifier
- 9984446535402771
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