Objective: To estimate 2-year mortality rates in HIV-1-infected and uninfected infants born to HIV+¬†and HIV‚àí¬†mothers.
Methods: Data are from a prospective study in rural¬†Rakai¬†District, Uganda. Infant HIV status (determined by polymerase chain reaction) was evaluated at 1 to 6 weeks postpartum and during breast-feeding, and maternal HIV viral load and¬†CD4¬†levels were measured at the postpartum visit. Multivariate Cox proportional hazards models and Kaplan-Meier survival analysis were used to assess survival of infants by maternal and infant HIV status and by quartiles of viral load. Log-rank tests were used to test the equality of survival functions.
Results: Of the 4604 pregnant women, 16.9% were HIV+, and the proportion of children infected was 20.9%. Median survival of HIV-infected infants was 23 months. Two-year child mortality rates were 128 of 1000 children born to HIV‚àí¬†mothers, 165.5 of 1000 uninfected children born to HIV+¬†mothers, and 540.1 of 1000 HIV-infected children (P¬†< 0.0001). Compared with children of¬†HIV‚àí¬†mothers, the hazard of child mortality was 2.04 (P¬†< 0.001) if the mother was HIV+¬†and 3.78 (P¬†< 0.001) if the infant was also infected. In the adjusted model, the highest quartiles of log10¬†HIV viral load in infants and mothers were associated with significantly increased hazard of child mortality (hazard ratio [HR] = 8.54 and HR = 2.50, respectively). Maternal¬†CD4¬†counts <200 cells/mL¬†were also significant predictors of child mortality (HR = 2.61). A total of 67.6% of HIV-infected children with viral loads above the median died by the age of 2 years and are in need of early¬†antiretroviral¬†therapy (ART).
Conclusions: More than half of HIV-infected infants died at less than 2 years of age. Therefore, ART may need to be initiated earlier in HIV-infected African children.