Morbidity Among HIV-1–Infected Mothers in Kenya
Identifieur interne : 002B19 ( Pmc/Checkpoint ); précédent : 002B18; suivant : 002B20Morbidity Among HIV-1–Infected Mothers in Kenya
Auteurs : Judd L. Walson [Kenya, États-Unis] ; Elizabeth R. Brown [États-Unis] ; Phelgona A. Otieno [Kenya] ; Dorothy A. Mbori-Ngacha [Kenya] ; Grace Wariua [Kenya] ; Elizabeth M. Obimbo [Kenya] ; Rose K. Bosire [Kenya] ; Carey Farquhar [États-Unis] ; Dalton Wamalwa [Kenya] ; Grace C. John-Stewart [États-Unis, Kenya]Source :
- Journal of Acquired Immune Deficiency Syndromes (1999) [ 1525-4135 ] ; 2007.
Abstract
Much of the burden of morbidity affecting women of childbearing age in sub-Saharan Africa occurs in the context of HIV-1 infection. Understanding patterns of illness and determinants of disease in HIV-1–infected mothers may guide effective interventions to improve maternal health in this setting.
We describe the incidence and cofactors of comorbidities affecting peripartum and postpartum HIV-1–infected women in Kenya. Women were evaluated by clinical examination and standardized questionnaires during pregnancy and for up to 2 years after delivery.
Five hundred thirty-five women were enrolled in the cohort (median CD4 count of 433 cells/mm3) and accrued 7736 person-months of follow-up. During 1-year follow-up, the incidence of upper respiratory tract infections was 161 per 100 person-years, incidence of pneumonia was 33 per 100 person-years, incidence of tuberculosis (TB) was 11 per 100 person-years, and incidence of diarrhea was 63 per 100 person-years. Immunosuppression and HIV-1 RNA levels were predictive for pneumonia, oral thrush, and TB but not for diarrhea; CD4 counts <200 cells/mm3 were associated with pneumonia (relative risk [RR] = 2.87, 95% confidence interval [CI]: 1.71 to 4.83), TB (RR = 7.14, 95% CI: 2.93 to 17.40) and thrush. The risk of diarrhea was significantly associated with crowding (RR = 1.86, 95% CI: 1.19 to 2.92) and breast-feeding (RR = 1.71, 95% CI: 1.19 to 2.44). Less than 10% of women reported hospitalization during 2-year follow-up; mortality risk in the cohort was 1.9% and 4.8% for 1 and 2 years, respectively.
Mothers with HIV-1, although generally healthy, have substantial morbidity as a result of common infections, some of which are predicted by immune status or by socioeconomic factors. Enhanced attention to maternal health is increasingly important as HIV-1–infected mothers transition from programs targeting the prevention of mother-to-child transmission to HIV care clinics.
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DOI: 10.1097/QAI.0b013e318141fcc0
PubMed: 17667334
PubMed Central: 3372412
Affiliations:
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<author><name sortKey="John Stewart, Grace C" sort="John Stewart, Grace C" uniqKey="John Stewart G" first="Grace C." last="John-Stewart">Grace C. John-Stewart</name>
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<placeName><region type="state">Washington (État)</region>
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<wicri:cityArea>Department of Medicine, University of Washington, Seattle</wicri:cityArea>
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<country xml:lang="fr">Kenya</country>
<wicri:regionArea>Department of Pediatrics, University of Nairobi, Nairobi</wicri:regionArea>
<wicri:noRegion>Nairobi</wicri:noRegion>
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<affiliation wicri:level="2"><nlm:aff id="A6">Department of Epidemiology, University of Washington, Seattle, WA</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<placeName><region type="state">Washington (État)</region>
</placeName>
<wicri:cityArea>Department of Epidemiology, University of Washington, Seattle</wicri:cityArea>
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<idno type="ISSN">1525-4135</idno>
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<front><div type="abstract" xml:lang="en"><sec id="S1"><title>Background</title>
<p id="P1">Much of the burden of morbidity affecting women of childbearing age in sub-Saharan Africa occurs in the context of HIV-1 infection. Understanding patterns of illness and determinants of disease in HIV-1–infected mothers may guide effective interventions to improve maternal health in this setting.</p>
</sec>
<sec id="S2"><title>Methods</title>
<p id="P2">We describe the incidence and cofactors of comorbidities affecting peripartum and postpartum HIV-1–infected women in Kenya. Women were evaluated by clinical examination and standardized questionnaires during pregnancy and for up to 2 years after delivery.</p>
</sec>
<sec id="S3"><title>Results</title>
<p id="P3">Five hundred thirty-five women were enrolled in the cohort (median CD4 count of 433 cells/mm<sup>3</sup>
) and accrued 7736 person-months of follow-up. During 1-year follow-up, the incidence of upper respiratory tract infections was 161 per 100 person-years, incidence of pneumonia was 33 per 100 person-years, incidence of tuberculosis (TB) was 11 per 100 person-years, and incidence of diarrhea was 63 per 100 person-years. Immunosuppression and HIV-1 RNA levels were predictive for pneumonia, oral thrush, and TB but not for diarrhea; CD4 counts <200 cells/mm<sup>3</sup>
were associated with pneumonia (relative risk [RR] = 2.87, 95% confidence interval [CI]: 1.71 to 4.83), TB (RR = 7.14, 95% CI: 2.93 to 17.40) and thrush. The risk of diarrhea was significantly associated with crowding (RR = 1.86, 95% CI: 1.19 to 2.92) and breast-feeding (RR = 1.71, 95% CI: 1.19 to 2.44). Less than 10% of women reported hospitalization during 2-year follow-up; mortality risk in the cohort was 1.9% and 4.8% for 1 and 2 years, respectively.</p>
</sec>
<sec id="S4"><title>Conclusions</title>
<p id="P4">Mothers with HIV-1, although generally healthy, have substantial morbidity as a result of common infections, some of which are predicted by immune status or by socioeconomic factors. Enhanced attention to maternal health is increasingly important as HIV-1–infected mothers transition from programs targeting the prevention of mother-to-child transmission to HIV care clinics.</p>
</sec>
</div>
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<front><journal-meta><journal-id journal-id-type="nlm-journal-id">100892005</journal-id>
<journal-id journal-id-type="pubmed-jr-id">21821</journal-id>
<journal-id journal-id-type="nlm-ta">J Acquir Immune Defic Syndr</journal-id>
<journal-id journal-id-type="iso-abbrev">J. Acquir. Immune Defic. Syndr.</journal-id>
<journal-title-group><journal-title>Journal of Acquired Immune Deficiency Syndromes (1999)</journal-title>
</journal-title-group>
<issn pub-type="ppub">1525-4135</issn>
<issn pub-type="epub">1944-7884</issn>
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<article-meta><article-id pub-id-type="pmid">17667334</article-id>
<article-id pub-id-type="pmc">3372412</article-id>
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<article-id pub-id-type="manuscript">NIHMS359131</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Article</subject>
</subj-group>
</article-categories>
<title-group><article-title>Morbidity Among HIV-1–Infected Mothers in Kenya</article-title>
<subtitle>Prevalence and Correlates of Illness During 2-Year Postpartum Follow-Up</subtitle>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Walson</surname>
<given-names>Judd L.</given-names>
</name>
<degrees>MD, MPH</degrees>
<xref ref-type="aff" rid="A1">*</xref>
<xref ref-type="aff" rid="A2">†</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Brown</surname>
<given-names>Elizabeth R.</given-names>
</name>
<degrees>ScD</degrees>
<xref ref-type="aff" rid="A3">‡</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Otieno</surname>
<given-names>Phelgona A.</given-names>
</name>
<degrees>MBChB, MMed, MPH</degrees>
<xref ref-type="aff" rid="A1">*</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Mbori-Ngacha</surname>
<given-names>Dorothy A.</given-names>
</name>
<degrees>MMed, MPH</degrees>
<xref ref-type="aff" rid="A4">§</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Wariua</surname>
<given-names>Grace</given-names>
</name>
<degrees>MBCHB</degrees>
<xref ref-type="aff" rid="A4">§</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Obimbo</surname>
<given-names>Elizabeth M.</given-names>
</name>
<degrees>MBChB, MMed, MPH</degrees>
<xref ref-type="aff" rid="A4">§</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Bosire</surname>
<given-names>Rose K.</given-names>
</name>
<degrees>MBChB, MPH</degrees>
<xref ref-type="aff" rid="A5">||</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Farquhar</surname>
<given-names>Carey</given-names>
</name>
<degrees>MD, MPH</degrees>
<xref ref-type="aff" rid="A2">†</xref>
<xref ref-type="aff" rid="A6">¶</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Wamalwa</surname>
<given-names>Dalton</given-names>
</name>
<degrees>MBChB, MMed, MPH</degrees>
<xref ref-type="aff" rid="A4">§</xref>
</contrib>
<contrib contrib-type="author"><name><surname>John-Stewart</surname>
<given-names>Grace C.</given-names>
</name>
<degrees>MD, PhD</degrees>
<xref ref-type="aff" rid="A2">†</xref>
<xref ref-type="aff" rid="A4">§</xref>
<xref ref-type="aff" rid="A6">¶</xref>
</contrib>
</contrib-group>
<aff id="A1"><label>*</label>
Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya</aff>
<aff id="A2"><label>†</label>
Department of Medicine, University of Washington, Seattle, WA</aff>
<aff id="A3"><label>‡</label>
Department of Biostatistics, University of Washington, Seattle, WA</aff>
<aff id="A4"><label>§</label>
Department of Pediatrics, University of Nairobi, Nairobi, Kenya</aff>
<aff id="A5"><label>||</label>
Centre for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya</aff>
<aff id="A6"><label>¶</label>
Department of Epidemiology, University of Washington, Seattle, WA</aff>
<author-notes><corresp id="FN1">Correspondence to: Judd L. WalsonMD, MPH, Department of Medicine, University of Washington, 325 Ninth Avenue, PO Box 359909, Seattle, WA 98104 (<email>walson@u.washington.edu</email>
)</corresp>
</author-notes>
<pub-date pub-type="nihms-submitted"><day>23</day>
<month>3</month>
<year>2012</year>
</pub-date>
<pub-date pub-type="ppub"><day>1</day>
<month>10</month>
<year>2007</year>
</pub-date>
<pub-date pub-type="pmc-release"><day>11</day>
<month>6</month>
<year>2012</year>
</pub-date>
<volume>46</volume>
<issue>2</issue>
<fpage>208</fpage>
<lpage>215</lpage>
<permissions><copyright-statement>Copyright © 2007 by Lippincott Williams & Wilkins</copyright-statement>
<copyright-year>2007</copyright-year>
</permissions>
<abstract><sec id="S1"><title>Background</title>
<p id="P1">Much of the burden of morbidity affecting women of childbearing age in sub-Saharan Africa occurs in the context of HIV-1 infection. Understanding patterns of illness and determinants of disease in HIV-1–infected mothers may guide effective interventions to improve maternal health in this setting.</p>
</sec>
<sec id="S2"><title>Methods</title>
<p id="P2">We describe the incidence and cofactors of comorbidities affecting peripartum and postpartum HIV-1–infected women in Kenya. Women were evaluated by clinical examination and standardized questionnaires during pregnancy and for up to 2 years after delivery.</p>
</sec>
<sec id="S3"><title>Results</title>
<p id="P3">Five hundred thirty-five women were enrolled in the cohort (median CD4 count of 433 cells/mm<sup>3</sup>
) and accrued 7736 person-months of follow-up. During 1-year follow-up, the incidence of upper respiratory tract infections was 161 per 100 person-years, incidence of pneumonia was 33 per 100 person-years, incidence of tuberculosis (TB) was 11 per 100 person-years, and incidence of diarrhea was 63 per 100 person-years. Immunosuppression and HIV-1 RNA levels were predictive for pneumonia, oral thrush, and TB but not for diarrhea; CD4 counts <200 cells/mm<sup>3</sup>
were associated with pneumonia (relative risk [RR] = 2.87, 95% confidence interval [CI]: 1.71 to 4.83), TB (RR = 7.14, 95% CI: 2.93 to 17.40) and thrush. The risk of diarrhea was significantly associated with crowding (RR = 1.86, 95% CI: 1.19 to 2.92) and breast-feeding (RR = 1.71, 95% CI: 1.19 to 2.44). Less than 10% of women reported hospitalization during 2-year follow-up; mortality risk in the cohort was 1.9% and 4.8% for 1 and 2 years, respectively.</p>
</sec>
<sec id="S4"><title>Conclusions</title>
<p id="P4">Mothers with HIV-1, although generally healthy, have substantial morbidity as a result of common infections, some of which are predicted by immune status or by socioeconomic factors. Enhanced attention to maternal health is increasingly important as HIV-1–infected mothers transition from programs targeting the prevention of mother-to-child transmission to HIV care clinics.</p>
</sec>
</abstract>
<kwd-group><kwd>HIV/AIDS</kwd>
<kwd>HIV-1 progression</kwd>
<kwd>maternal health</kwd>
<kwd>morbidity</kwd>
<kwd>postpartum</kwd>
<kwd>pregnancy</kwd>
<kwd>prevention of mother-to-child transmission</kwd>
<kwd>women</kwd>
</kwd-group>
<funding-group><award-group><funding-source country="United States">National Institute of Child Health & Human Development : NICHD</funding-source>
<award-id>R01 HD023412-13 || HD</award-id>
</award-group>
<award-group><funding-source country="United States">National Institute of Allergy and Infectious Diseases Extramural Activities : NIAID</funding-source>
<award-id>P30 AI027757-16 || AI</award-id>
</award-group>
</funding-group>
</article-meta>
</front>
</pmc>
<affiliations><list><country><li>Kenya</li>
<li>États-Unis</li>
</country>
<region><li>Washington (État)</li>
</region>
</list>
<tree><country name="Kenya"><noRegion><name sortKey="Walson, Judd L" sort="Walson, Judd L" uniqKey="Walson J" first="Judd L." last="Walson">Judd L. Walson</name>
</noRegion>
<name sortKey="Bosire, Rose K" sort="Bosire, Rose K" uniqKey="Bosire R" first="Rose K." last="Bosire">Rose K. Bosire</name>
<name sortKey="John Stewart, Grace C" sort="John Stewart, Grace C" uniqKey="John Stewart G" first="Grace C." last="John-Stewart">Grace C. John-Stewart</name>
<name sortKey="Mbori Ngacha, Dorothy A" sort="Mbori Ngacha, Dorothy A" uniqKey="Mbori Ngacha D" first="Dorothy A." last="Mbori-Ngacha">Dorothy A. Mbori-Ngacha</name>
<name sortKey="Obimbo, Elizabeth M" sort="Obimbo, Elizabeth M" uniqKey="Obimbo E" first="Elizabeth M." last="Obimbo">Elizabeth M. Obimbo</name>
<name sortKey="Otieno, Phelgona A" sort="Otieno, Phelgona A" uniqKey="Otieno P" first="Phelgona A." last="Otieno">Phelgona A. Otieno</name>
<name sortKey="Wamalwa, Dalton" sort="Wamalwa, Dalton" uniqKey="Wamalwa D" first="Dalton" last="Wamalwa">Dalton Wamalwa</name>
<name sortKey="Wariua, Grace" sort="Wariua, Grace" uniqKey="Wariua G" first="Grace" last="Wariua">Grace Wariua</name>
</country>
<country name="États-Unis"><region name="Washington (État)"><name sortKey="Walson, Judd L" sort="Walson, Judd L" uniqKey="Walson J" first="Judd L." last="Walson">Judd L. Walson</name>
</region>
<name sortKey="Brown, Elizabeth R" sort="Brown, Elizabeth R" uniqKey="Brown E" first="Elizabeth R." last="Brown">Elizabeth R. Brown</name>
<name sortKey="Farquhar, Carey" sort="Farquhar, Carey" uniqKey="Farquhar C" first="Carey" last="Farquhar">Carey Farquhar</name>
<name sortKey="Farquhar, Carey" sort="Farquhar, Carey" uniqKey="Farquhar C" first="Carey" last="Farquhar">Carey Farquhar</name>
<name sortKey="John Stewart, Grace C" sort="John Stewart, Grace C" uniqKey="John Stewart G" first="Grace C." last="John-Stewart">Grace C. John-Stewart</name>
<name sortKey="John Stewart, Grace C" sort="John Stewart, Grace C" uniqKey="John Stewart G" first="Grace C." last="John-Stewart">Grace C. John-Stewart</name>
</country>
</tree>
</affiliations>
</record>
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