16th International AIDS Conference Toronto, Canada - August 13 - 18, 2006

CHILD MORTALITY ACCORDING TO MATERNAL AND INFANT HIV STATUS IN ZIMBABWE

Int Conf AIDS. 2006 Aug 13-18;16 Abstract No. ThAc0203

Marinda E.¹, Humphrey J.H.², Iliff P.J.³, Mutasa K.³, Piwoz E.G.⁴, Moulton L.H.², Nathoo K.J.⁵, Ward B.J.⁶, Salama P.⁷, ZVITAMBO Study Group
¹ ZVITAMBO, Harare, Zimbabwe, Currently University of Witswatersrand, Harare, Zimbabwe, ² Johns Hopkins Bloomberg School of Public Health, International Health, Baltimore, Maryland, United States, ³ ZVITAMBO Project, Harare, Zimbabwe, ⁴ Academy for Eduational Development, Washington DC, United States, ⁵ University of Zimbabwe, College of Health Science, Department of Paediatrics and Child Health, Harare, Zimbabwe, ⁶ Research Institute of the Montreal General Hospital, Montreal, Quebec, Canada, 7UNICEF, New York, NY, United States

BACKGROUND: Risk factors and cause of death for HIV-infected African children are inadequately described.

METHODS: We analyzed rates and causes of death among children enrolled in the ZVITAMBO trial (conducted from 1998 – 2001), born to HIV-negative mothers (NE, n=9510) and to HIV-positive mothers who were themselves not infected (NI, n=3135), and infected in-utero (IU, n=381), intrapartum (IP, n=508), and postnatally (PN, n=258). Cause of death was determined from hospital records or verbal autopsy.

RESULTS: 2-year mortality was 2.9%, 9.2%, 33.2%, 65.1%, and 67.5% for NE, NI, PN, IP, and IU infants, respectively. Among infants whose mortality could be defined from birth, 50%, 38%, but only 8% of infant mortality occurred <8 weeks for NE, NI, and IU infants, respectively. Between 8 weeks and 6 months, mortality declined by 50% and 73% for NI and NE infants, respectively, but quintupled (from 309 to 1686/1000 c-y) for IU infants. The median time from infection to death was 208 and 380 days for IU and IP infants, respectively; time to 25% mortality was 274 days for PN infants infected <6 mo and 485 days for PN infants infected >6 mo. Among NI children, indicators of maternal severity of illness (death, anemia, low arm circumference, low CD4) and social vulnerability (unmarried and low income) were predictive of mortality. Acute respiratory infection was associated with 50%, 58%, 67%, 77% and 77% of deaths among NE, NI, PN, IP, and IU infants, respectively.

CONCLUSIONS: Mortality is exceedingly high among HIV-infected children. The earlier children are infected, the faster they die. Respiratory infection is by far the major cause of their deaths. These data highlight the need for timely antiretroviral treatment and cotrimoxazole prophylaxis for HIV-infected children.

Funding provided by CIDA, USAID, Rockefeller Foundation, BASF.

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2006-08-13
ThAc0203

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