Predictors of early mortality in a cohort of human immunodeficiency virus type 1-infected African children.

Abstract

Background: Pediatric human immunodeficiency virus type 1 (HIV-1) infection follows a bimodal clinical course with rapid progression in 10–45% of children before the age of 2 years and slower progression in the remainder. A prospective observational study was undertaken to determine predictors of mortality in HIV- 1-infected African infants during the first 2 years of life. Methods: Infants in a perinatal cohort identified to be HIV-1- infected by DNA PCR were followed monthly to 1 year, then quarterly to 2 years or death. Results: Among 62 HIV-1-infected infants, infection occurred by the age of 1 month in 56 (90%) infants, and 32 (52%) died at median age of 6.2 months. All infant deaths were caused by infectious diseases, most frequently pneumonia (75%) and diarrhea (41%). Univariate predictors of infant mortality included maternal CD4 count 200 cells/ l hazard ratio (HR), 3.4; P 0.008 , maternal anemia (HR 3.7; P 0.005), delivery complications (HR 2.7; P 0.01), low birth weight (HR 4.1; P 0.001), weight, length and head circumference 5th percentile at age 1 month (HR 3.7, P 0.003; HR 5.8, P 0.001; and HR 10.4, P 0.001, respectively), formula-feeding (HR 4.0; P 0.01), infant CD4% 15% (HR 5.5; P 0.01), infant CD4 count 750 (HR 9.7; P 0.006) and maternal death (HR 2.9, P 0.05). In multivariate analysis, maternal CD4 count 200 (HR 2.7; P 0.03) and delivery complications (HR 3.4; P 0.005) were independently associated with infant mortality. Conclusions: Advanced maternal HIV disease, maternal anemia, delivery complications, early growth faltering, formula-feeding and low infant CD4 were predictors of early mortality in African HIV-1-infected infants. In resource-poor settings, these predictors may be useful for early identification and treatment of high risk infants