SidaSubSaharaV1, Pmc, Corpus, bibRecord, 001E80

Does Severity of HIV Disease in HIV-Infected Mothers Affect Mortality and Morbidity among Their Uninfected Infants?

Identifieur interne : 001E80 ( Pmc/Corpus ); précédent : 001E79; suivant : 001E81

Does Severity of HIV Disease in HIV-Infected Mothers Affect Mortality and Morbidity among Their Uninfected Infants?

Auteurs : Louise Kuhn ; Prisca Kasonde ; Moses Sinkala ; Chipepo Kankasa ; Katherine Semrau ; Nancy Scott ; Wei-Yann Tsai ; Sten H. Vermund ; Grace M. Aldrovandi ; Donald M. Thea

Source :

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [ 1058-4838 ] ; 2005.

RBID : PMC:1351118

Abstract

Background

Rates of perinatal human immunodeficiency virus (HIV) transmission are higher among HIV-infected mothers with more advanced disease, but effects of maternal disease on HIV-uninfected offspring are unclear. We investigated the hypothesis that the severity of HIV disease and immune dysfunction among mothers is associated with increased morbidity and mortality among their uninfected infants.

Methods

In a birth cohort of 620 HIV-uninfected infants born to HIV-infected mothers in Lusaka, Zambia, we investigated associations between markers of more advanced maternal HIV disease and child mortality, hospital admissions, and infant weight through 4 months of age.

Results

Mortality in the cohort of uninfected infants was 4.6% (95% confidence interval [CI], 2.8–6.3) through 4 months of age. Infants of mothers with CD4⁺ T cell counts of <350 cells/μL were more likely to die (hazard ratio [HR], 2.87; 95% CI, 1.03–8.03) and were more likely to be hospitalized (HR, 2.28; 95% CI, 1.17–4.45), after adjusting for other factors, including maternal death and low birth weight. The most common cause of infant death and hospitalization was pneumonia and/or sepsis. A maternal viral load of >100,000 copies/mL was associated with significantly lower child weight through 4 months of age.

Conclusion

Children born to HIV-infected mothers with advanced disease who escaped perinatal or early breastfeeding-related HIV infection are nonetheless at high risk of mortality and morbidity during the first few months of life. HIV-related immunosuppression appears to have adverse consequences for the health of infants, in addition to risks of vertical transmission.

Url:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1351118

DOI: 10.1086/498029
PubMed: 16267740
PubMed Central: 1351118

Links to Exploration step

PMC:1351118

Le document en format XML

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<author><name sortKey="Kuhn, Louise" sort="Kuhn, Louise" uniqKey="Kuhn L" first="Louise" last="Kuhn">Louise Kuhn</name>
<affiliation><nlm:aff id="A1"> Gertrude H. Sergievsky Center and Departments of</nlm:aff>
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<affiliation><nlm:aff wicri:cut=" and" id="A2"> Epidemiology</nlm:aff>
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<author><name sortKey="Kasonde, Prisca" sort="Kasonde, Prisca" uniqKey="Kasonde P" first="Prisca" last="Kasonde">Prisca Kasonde</name>
<affiliation><nlm:aff wicri:cut=", and" id="A7"> University Teaching Hospital, University of Zambia</nlm:aff>
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<author><name sortKey="Sinkala, Moses" sort="Sinkala, Moses" uniqKey="Sinkala M" first="Moses" last="Sinkala">Moses Sinkala</name>
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<author><name sortKey="Semrau, Katherine" sort="Semrau, Katherine" uniqKey="Semrau K" first="Katherine" last="Semrau">Katherine Semrau</name>
<affiliation><nlm:aff id="A4"> Center for International Health and Development, Boston University School of Public Health, Boston, Massachusetts;</nlm:aff>
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<author><name sortKey="Scott, Nancy" sort="Scott, Nancy" uniqKey="Scott N" first="Nancy" last="Scott">Nancy Scott</name>
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<author><name sortKey="Tsai, Wei Yann" sort="Tsai, Wei Yann" uniqKey="Tsai W" first="Wei-Yann" last="Tsai">Wei-Yann Tsai</name>
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<author><name sortKey="Aldrovandi, Grace M" sort="Aldrovandi, Grace M" uniqKey="Aldrovandi G" first="Grace M." last="Aldrovandi">Grace M. Aldrovandi</name>
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<author><name sortKey="Thea, Donald M" sort="Thea, Donald M" uniqKey="Thea D" first="Donald M." last="Thea">Donald M. Thea</name>
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<author><name sortKey="Sinkala, Moses" sort="Sinkala, Moses" uniqKey="Sinkala M" first="Moses" last="Sinkala">Moses Sinkala</name>
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</affiliation>
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<author><name sortKey="Kankasa, Chipepo" sort="Kankasa, Chipepo" uniqKey="Kankasa C" first="Chipepo" last="Kankasa">Chipepo Kankasa</name>
<affiliation><nlm:aff wicri:cut=", and" id="A7"> University Teaching Hospital, University of Zambia</nlm:aff>
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<author><name sortKey="Semrau, Katherine" sort="Semrau, Katherine" uniqKey="Semrau K" first="Katherine" last="Semrau">Katherine Semrau</name>
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<author><name sortKey="Scott, Nancy" sort="Scott, Nancy" uniqKey="Scott N" first="Nancy" last="Scott">Nancy Scott</name>
<affiliation><nlm:aff id="A4"> Center for International Health and Development, Boston University School of Public Health, Boston, Massachusetts;</nlm:aff>
</affiliation>
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<author><name sortKey="Tsai, Wei Yann" sort="Tsai, Wei Yann" uniqKey="Tsai W" first="Wei-Yann" last="Tsai">Wei-Yann Tsai</name>
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<author><name sortKey="Vermund, Sten H" sort="Vermund, Sten H" uniqKey="Vermund S" first="Sten H." last="Vermund">Sten H. Vermund</name>
<affiliation><nlm:aff id="A5"> Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham;</nlm:aff>
</affiliation>
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<author><name sortKey="Aldrovandi, Grace M" sort="Aldrovandi, Grace M" uniqKey="Aldrovandi G" first="Grace M." last="Aldrovandi">Grace M. Aldrovandi</name>
<affiliation><nlm:aff wicri:cut="; and" id="A6"> Department of Pediatrics, University of Southern California, Los Angeles</nlm:aff>
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<author><name sortKey="Thea, Donald M" sort="Thea, Donald M" uniqKey="Thea D" first="Donald M." last="Thea">Donald M. Thea</name>
<affiliation><nlm:aff id="A4"> Center for International Health and Development, Boston University School of Public Health, Boston, Massachusetts;</nlm:aff>
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<front><div type="abstract" xml:lang="en"><sec id="S16"><title>Background</title>
<p id="P1">Rates of perinatal human immunodeficiency virus (HIV) transmission are higher among HIV-infected mothers with more advanced disease, but effects of maternal disease on HIV-uninfected offspring are unclear. We investigated the hypothesis that the severity of HIV disease and immune dysfunction among mothers is associated with increased morbidity and mortality among their uninfected infants.</p>
</sec>
<sec sec-type="methods" id="S17"><title>Methods</title>
<p id="P2">In a birth cohort of 620 HIV-uninfected infants born to HIV-infected mothers in Lusaka, Zambia, we investigated associations between markers of more advanced maternal HIV disease and child mortality, hospital admissions, and infant weight through 4 months of age.</p>
</sec>
<sec id="S18"><title>Results</title>
<p id="P3">Mortality in the cohort of uninfected infants was 4.6% (95% confidence interval [CI], 2.8–6.3) through 4 months of age. Infants of mothers with CD4<sup>+</sup>
 T cell counts of <350 cells/μL were more likely to die (hazard ratio [HR], 2.87; 95% CI, 1.03–8.03) and were more likely to be hospitalized (HR, 2.28; 95% CI, 1.17–4.45), after adjusting for other factors, including maternal death and low birth weight. The most common cause of infant death and hospitalization was pneumonia and/or sepsis. A maternal viral load of >100,000 copies/mL was associated with significantly lower child weight through 4 months of age.</p>
</sec>
<sec id="S19"><title>Conclusion</title>
<p id="P4">Children born to HIV-infected mothers with advanced disease who escaped perinatal or early breastfeeding-related HIV infection are nonetheless at high risk of mortality and morbidity during the first few months of life. HIV-related immunosuppression appears to have adverse consequences for the health of infants, in addition to risks of vertical transmission.</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">9203213</journal-id>
<journal-id journal-id-type="pubmed-jr-id">1135</journal-id>
<journal-id journal-id-type="nlm-ta">Clin Infect Dis</journal-id>
<journal-title>Clinical infectious diseases : an official publication of the Infectious Diseases Society of America</journal-title>
<issn pub-type="ppub">1058-4838</issn>
<issn pub-type="epub">1537-6591</issn>
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<article-id pub-id-type="doi">10.1086/498029</article-id>
<article-id pub-id-type="manuscript">NIHMS7249</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Article</subject>
</subj-group>
</article-categories>
<title-group><article-title>Does Severity of HIV Disease in HIV-Infected Mothers Affect Mortality and Morbidity among Their Uninfected Infants?</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Kuhn</surname>
<given-names>Louise</given-names>
</name>
<xref rid="A1" ref-type="aff">1</xref>
<xref rid="A2" ref-type="aff">2</xref>
<xref rid="FN1" ref-type="author-notes"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Kasonde</surname>
<given-names>Prisca</given-names>
</name>
<xref rid="A7" ref-type="aff">7</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Sinkala</surname>
<given-names>Moses</given-names>
</name>
<xref rid="A8" ref-type="aff">8</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Kankasa</surname>
<given-names>Chipepo</given-names>
</name>
<xref rid="A7" ref-type="aff">7</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Semrau</surname>
<given-names>Katherine</given-names>
</name>
<xref rid="A4" ref-type="aff">4</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Scott</surname>
<given-names>Nancy</given-names>
</name>
<xref rid="A4" ref-type="aff">4</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Tsai</surname>
<given-names>Wei-Yann</given-names>
</name>
<xref rid="A3" ref-type="aff">3</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Vermund</surname>
<given-names>Sten H.</given-names>
</name>
<xref rid="A5" ref-type="aff">5</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Aldrovandi</surname>
<given-names>Grace M.</given-names>
</name>
<xref rid="A6" ref-type="aff">6</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Thea</surname>
<given-names>Donald M.</given-names>
</name>
<xref rid="A4" ref-type="aff">4</xref>
</contrib>
<aff id="A1"><label>1</label>
 Gertrude H. Sergievsky Center and Departments of</aff>
<aff id="A2"><label>2</label>
 Epidemiology and</aff>
<aff id="A3"><label>3</label>
 Biostatistics, Mailman School of Public Health, Columbia University, New York, New York;</aff>
<aff id="A4"><label>4</label>
 Center for International Health and Development, Boston University School of Public Health, Boston, Massachusetts;</aff>
<aff id="A5"><label>5</label>
 Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham;</aff>
<aff id="A6"><label>6</label>
 Department of Pediatrics, University of Southern California, Los Angeles; and</aff>
<aff id="A7"><label>7</label>
 University Teaching Hospital, University of Zambia, and</aff>
<aff id="A8"><label>8</label>
 Lusaka District Health Management Team, Lusaka, Zambia</aff>
</contrib-group>
<author-notes><corresp id="FN1">Reprints or correspondence: Dr. Louise Kuhn, Sergievsky Center, Columbia University, 630 W. 168th St., New York, NY 10032 (<email>lk24@columbia.edu</email>
).</corresp>
</author-notes>
<pub-date pub-type="nihms-submitted"><day>28</day>
<month>12</month>
<year>2005</year>
</pub-date>
<pub-date pub-type="epub"><day>27</day>
<month>10</month>
<year>2005</year>
</pub-date>
<pub-date pub-type="ppub"><day>1</day>
<month>12</month>
<year>2005</year>
</pub-date>
<pub-date pub-type="pmc-release"><day>25</day>
<month>1</month>
<year>2006</year>
</pub-date>
<volume>41</volume>
<issue>11</issue>
<fpage>1654</fpage>
<lpage>1661</lpage>
<abstract><sec id="S16"><title>Background</title>
<p id="P1">Rates of perinatal human immunodeficiency virus (HIV) transmission are higher among HIV-infected mothers with more advanced disease, but effects of maternal disease on HIV-uninfected offspring are unclear. We investigated the hypothesis that the severity of HIV disease and immune dysfunction among mothers is associated with increased morbidity and mortality among their uninfected infants.</p>
</sec>
<sec sec-type="methods" id="S17"><title>Methods</title>
<p id="P2">In a birth cohort of 620 HIV-uninfected infants born to HIV-infected mothers in Lusaka, Zambia, we investigated associations between markers of more advanced maternal HIV disease and child mortality, hospital admissions, and infant weight through 4 months of age.</p>
</sec>
<sec id="S18"><title>Results</title>
<p id="P3">Mortality in the cohort of uninfected infants was 4.6% (95% confidence interval [CI], 2.8–6.3) through 4 months of age. Infants of mothers with CD4<sup>+</sup>
 T cell counts of <350 cells/μL were more likely to die (hazard ratio [HR], 2.87; 95% CI, 1.03–8.03) and were more likely to be hospitalized (HR, 2.28; 95% CI, 1.17–4.45), after adjusting for other factors, including maternal death and low birth weight. The most common cause of infant death and hospitalization was pneumonia and/or sepsis. A maternal viral load of >100,000 copies/mL was associated with significantly lower child weight through 4 months of age.</p>
</sec>
<sec id="S19"><title>Conclusion</title>
<p id="P4">Children born to HIV-infected mothers with advanced disease who escaped perinatal or early breastfeeding-related HIV infection are nonetheless at high risk of mortality and morbidity during the first few months of life. HIV-related immunosuppression appears to have adverse consequences for the health of infants, in addition to risks of vertical transmission.</p>
</sec>
</abstract>
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</article-meta>
</front>
</pmc>
</record>

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Does Severity of HIV Disease in HIV-Infected Mothers Affect Mortality and Morbidity among Their Uninfected Infants?

Does Severity of HIV Disease in HIV-Infected Mothers Affect Mortality and Morbidity among Their Uninfected Infants?

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Abstract

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