Morbidity Among HIV-1–Infected Mothers in Kenya
Identifieur interne : 001894 ( Pmc/Corpus ); précédent : 001893; suivant : 001895Morbidity Among HIV-1–Infected Mothers in Kenya
Auteurs : Judd L. Walson ; Elizabeth R. Brown ; Phelgona A. Otieno ; Dorothy A. Mbori-Ngacha ; Grace Wariua ; Elizabeth M. Obimbo ; Rose K. Bosire ; Carey Farquhar ; Dalton Wamalwa ; Grace C. John-StewartSource :
- 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
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Otieno</name><affiliation><nlm:aff id="A1">Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya</nlm:aff></affiliation></author><author><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><affiliation><nlm:aff id="A4">Department of Pediatrics, University of Nairobi, Nairobi, Kenya</nlm:aff></affiliation></author><author><name sortKey="Wariua, Grace" sort="Wariua, Grace" uniqKey="Wariua G" first="Grace" last="Wariua">Grace Wariua</name><affiliation><nlm:aff id="A4">Department of Pediatrics, University of Nairobi, Nairobi, Kenya</nlm:aff></affiliation></author><author><name sortKey="Obimbo, Elizabeth M" sort="Obimbo, Elizabeth M" uniqKey="Obimbo E" first="Elizabeth M." last="Obimbo">Elizabeth M. Obimbo</name><affiliation><nlm:aff id="A4">Department of Pediatrics, University of Nairobi, Nairobi, Kenya</nlm:aff></affiliation></author><author><name sortKey="Bosire, Rose K" sort="Bosire, Rose K" uniqKey="Bosire R" first="Rose K." last="Bosire">Rose K. Bosire</name><affiliation><nlm:aff id="A5">Centre for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya</nlm:aff></affiliation></author><author><name sortKey="Farquhar, Carey" sort="Farquhar, Carey" uniqKey="Farquhar C" first="Carey" last="Farquhar">Carey Farquhar</name><affiliation><nlm:aff id="A2">Department of Medicine, University of Washington, Seattle, WA</nlm:aff></affiliation><affiliation><nlm:aff id="A6">Department of Epidemiology, University of Washington, Seattle, WA</nlm:aff></affiliation></author><author><name sortKey="Wamalwa, Dalton" sort="Wamalwa, Dalton" uniqKey="Wamalwa D" first="Dalton" last="Wamalwa">Dalton Wamalwa</name><affiliation><nlm:aff id="A4">Department of Pediatrics, University of Nairobi, Nairobi, Kenya</nlm:aff></affiliation></author><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><affiliation><nlm:aff id="A2">Department of Medicine, University of Washington, Seattle, WA</nlm:aff></affiliation><affiliation><nlm:aff id="A4">Department of Pediatrics, University of Nairobi, Nairobi, Kenya</nlm:aff></affiliation><affiliation><nlm:aff id="A6">Department of Epidemiology, University of Washington, Seattle, WA</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">17667334</idno><idno type="pmc">3372412</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3372412</idno><idno type="RBID">PMC:3372412</idno><idno type="doi">10.1097/QAI.0b013e318141fcc0</idno><date when="2007">2007</date><idno type="wicri:Area/Pmc/Corpus">001894</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001894</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Morbidity Among HIV-1–Infected Mothers in Kenya</title><author><name sortKey="Walson, Judd L" sort="Walson, Judd L" uniqKey="Walson J" first="Judd L." last="Walson">Judd L. Walson</name><affiliation><nlm:aff id="A1">Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya</nlm:aff></affiliation><affiliation><nlm:aff id="A2">Department of Medicine, University of Washington, Seattle, WA</nlm:aff></affiliation></author><author><name sortKey="Brown, Elizabeth R" sort="Brown, Elizabeth R" uniqKey="Brown E" first="Elizabeth R." last="Brown">Elizabeth R. Brown</name><affiliation><nlm:aff id="A3">Department of Biostatistics, University of Washington, Seattle, WA</nlm:aff></affiliation></author><author><name sortKey="Otieno, Phelgona A" sort="Otieno, Phelgona A" uniqKey="Otieno P" first="Phelgona A." last="Otieno">Phelgona A. Otieno</name><affiliation><nlm:aff id="A1">Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya</nlm:aff></affiliation></author><author><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><affiliation><nlm:aff id="A4">Department of Pediatrics, University of Nairobi, Nairobi, Kenya</nlm:aff></affiliation></author><author><name sortKey="Wariua, Grace" sort="Wariua, Grace" uniqKey="Wariua G" first="Grace" last="Wariua">Grace Wariua</name><affiliation><nlm:aff id="A4">Department of Pediatrics, University of Nairobi, Nairobi, Kenya</nlm:aff></affiliation></author><author><name sortKey="Obimbo, Elizabeth M" sort="Obimbo, Elizabeth M" uniqKey="Obimbo E" first="Elizabeth M." last="Obimbo">Elizabeth M. Obimbo</name><affiliation><nlm:aff id="A4">Department of Pediatrics, University of Nairobi, Nairobi, Kenya</nlm:aff></affiliation></author><author><name sortKey="Bosire, Rose K" sort="Bosire, Rose K" uniqKey="Bosire R" first="Rose K." last="Bosire">Rose K. Bosire</name><affiliation><nlm:aff id="A5">Centre for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya</nlm:aff></affiliation></author><author><name sortKey="Farquhar, Carey" sort="Farquhar, Carey" uniqKey="Farquhar C" first="Carey" last="Farquhar">Carey Farquhar</name><affiliation><nlm:aff id="A2">Department of Medicine, University of Washington, Seattle, WA</nlm:aff></affiliation><affiliation><nlm:aff id="A6">Department of Epidemiology, University of Washington, Seattle, WA</nlm:aff></affiliation></author><author><name sortKey="Wamalwa, Dalton" sort="Wamalwa, Dalton" uniqKey="Wamalwa D" first="Dalton" last="Wamalwa">Dalton Wamalwa</name><affiliation><nlm:aff id="A4">Department of Pediatrics, University of Nairobi, Nairobi, Kenya</nlm:aff></affiliation></author><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><affiliation><nlm:aff id="A2">Department of Medicine, University of Washington, Seattle, WA</nlm:aff></affiliation><affiliation><nlm:aff id="A4">Department of Pediatrics, University of Nairobi, Nairobi, Kenya</nlm:aff></affiliation><affiliation><nlm:aff id="A6">Department of Epidemiology, University of Washington, Seattle, WA</nlm:aff></affiliation></author></analytic><series><title level="j">Journal of Acquired Immune Deficiency Syndromes (1999)</title><idno type="ISSN">1525-4135</idno><idno type="eISSN">1944-7884</idno><imprint><date when="2007">2007</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><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></front></TEI><pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<pmc-dir>properties manuscript</pmc-dir>
<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></journal-meta><article-meta><article-id pub-id-type="pmid">17667334</article-id><article-id pub-id-type="pmc">3372412</article-id><article-id pub-id-type="doi">10.1097/QAI.0b013e318141fcc0</article-id><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></record>Pour manipuler ce document sous Unix (Dilib)
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