Background:

HIV causes substantial mortality among African children but there is limited data on how this is influenced by maternal or infant infection status and timing.

Methods:

Children enrolled in the ZVITAMBO trial were divided into 5 groups: those born to HIV-negative mothers (NE, n= 9510), those born to HIV-positive mothers but noninfected (NI, n= 3135), those infected in utero (IU, n= 381), those infected intrapartum (IP, n= 508), and those infected postnatally (PN, n= 258). Their mortality was estimated.

Results:

Two-year mortality was 2.9%(NE infants), 9.2%(NI), 67.5%(IU), 65.1%(IP), and 33.2%(PN). Between 8 weeks and 6 months, mortality in IU infants quintupled (from 309 to 1686/1000 cy). The median time from infection to death was 208, 380, and> 500 days for IU, IP, and PN infants, respectively. Among NI children, advanced maternal disease was predictive of mortality. Acute respiratory infection was the major cause of death.

Conclusions:

Perinatally infected infants are at particular risk of death between 2 and 6 months: cotrimoxazole prophylaxis and early pediatric HAART should be scaled up. Uninfected infants of infected mothers have at least twice the mortality risk of infants born to uninfected mothers: all HIV-exposed infants should be targeted with child survival interventions. HIV-positive mothers with more advanced disease are not only more likely to infect their infants, but their infants are more likely to die, whether infected or not: provision of antiretroviral treatment to pregnant and lactating women is an urgent need for both mothers and their children.