Morbidity and Mortality Among a Cohort of Human Immunodeficiency Virus Type 1-Infected and Uninfected Pregnant Women and Their Infants From Malawi, Zambia, and Tanzania

Abstract

Background: Morbidity and mortality patterns among pregnant women and their infants (before antiretroviral therapy was widely available) determines HIV-1 diagnostic, monitoring, and care interventions. Methods: Data from mothers and their infants enrolled in a trial of antibiotics to reduce mother-to-child-transmission of HIV-1 at 4 sub-Saharan African sites were analyzed. Women were enrolled during pregnancy and follow-up continued until the infants reached 12 months of age. We describe maternal and infant morbidity and mortality in a cohort of HIV-1-infected and HIV-1-uninfected mothers. Maternal and infant factors associated with mortality risk in the infants were assessed using Cox proportional hazard modeling. Results: Among 2292 HIV-1-infected mothers, 166 (7.2%) had a serious adverse event (SAE) and 42 (1.8%) died, whereas no deaths occurred among the 331 HIV-1 uninfected mothers. Four hundred twenty-four (17.8%) of 2383 infants had an SAE and 349 (16.4%) died before the end of follow-up. Infants with early HIV-1 infection (birth to 4 – 6 weeks) had the highest mortality. Among infants born to HIV-1-infected women, maternal morbidity and mortality (P = 0.0001), baseline CD4 count (P = 0.0002), and baseline plasma HIV-1 RNA concentration (P < 0.0001) were significant predictors of infant mortality in multivariate analyses. Conclusions: The high mortality among infants with early HIV-1 infection supports access to HIV-1 diagnostics and appropriate early treatment for all infants of HIV-1-infected mothers. The significant association between stage of maternal HIV-1 infection and infant mortality supports routine CD4 counts at the time of prenatal HIV-1 testing.

Maternal HIV infection is an important health determinant in non-HIV-infected infants

“…Cohort studies from other sub-Saharan countries have shown that, before the availability of ART, HEU children had a higher mortality risk than HIV-unexposed children [4,6,29]. However, reports on mortality in HEU and HIVunexposed children in the ARTera are scarce, and results are heterogeneous [19,[30][31][32][33]. Mortality rate in HEU children in this study (2.2 deaths per 100 live births per year at risk) was lower than that reported from other countries in sub-Saharan Africa in the ART era, though Cox proportional hazard models.…”

Preponderance of bacterial isolates in urine of HIV-positive malaria-infected pregnant women with urinary tract infection

“…The report also estimated that the prevalence of HIV in pregnant women is over 30% in some countries of southern Africa. Approximately 2%-8% of pregnant women die of pregnancy-related illnesses in developing countries, partly because of HIV and malaria complications [11] and also due to lack of access to antiretroviral drugs (ARVs) [12]. Studies have reported that HIV patients with malaria have a higher frequency of symptomatic malaria and that malaria may increase HIV plasma viral load and decrease CD4+ T cells [13,14].…”

“…HIV infection in pregnancy has become the most common medical complication of pregnancy in some countries in sub-Saharan Africa [11]. It has been reported that over 70% of all HIV infections are a result of heterosexual contacts and that over 90% of infections in children come from mother-to-child transmission [5].…”

The Rationale for Probiotics Improving Reproductive Health and Pregnancy Outcome

“…Some differences exist between races, but these are more likely influenced by diet, menstrual status, sexual practices, socioeconomic status, and culture than host genetics. [7][8][9][10][11][12] The problems that women in the developed world perhaps view as most important, namely being able to conceive, avoid preterm labor and diabetes, and control the impact of infectious agents, are contrasted with those of resource-disadvantaged countries where women often die or suffer through violent acts, inadequate access to care, sexually transmitted infections including HIV, and their babies through birthing problems, malnutrition, and environmental challenges [13][14][15][16][17] (Fig. 1).…”