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HIV exposure causes 50% of infant deaths at 24 months in Botswana

BOSTON — HIV exposure and infection accounted for more than half of the deaths among children aged 24 months in Botswana, a country with widespread availability of maternal and infant ART, according to data presented at CROI 2016.

“In a programmatic setting with high HIV prevalence, widespread maternal uptake of three-drug ART in pregnancy, and resultant low rates of mother-to-child-transmission of HIV, HIV-exposed children account for more than half of all deaths in the first 24 months of life,” Rebecca Zash, MD, of Beth Israel Deaconess Medical Center, told Infectious Diseases in Children. “This is important because with the increased risk of mortality among HIV-exposed, but uninfected children, reaching international goals for reductions in child mortality will only be possible when maternal HIV prevalence is decreased drastically even if mother-to-child transmission rates fall well below 1%.”

The researchers enrolled 3,000 mothers from five geographically diverse postpartum wards in Botswana from March 2012 to March 2013. They interviewed participants every 1 to 3 months for 24 months to record the HIV status of their newborn children, feeding methods, food security, child mortality and maternal mortality. HIV-infected mothers and children received government-sponsored ART.

Of the 3,033 infants analyzed during the study, 1,515 were either HIV-infected by mother-to-child transmission or HIV-exposed but uninfected during gestation. Zash and colleagues wrote that 106 children died during the study, including 70 who were HIV-exposed but uninfected and 12 who were HIV-infected.

The researchers found that child HIV infection (adjusted HR = 22.6; 95% CI, 10.7-47.5), child HIV exposure (aHR = 2.7; 95% CI, 1.7-4.5) and maternal death (aHR = 7.7; 95% CI, 1.9-31.9) were the only independent risk factors associated with infant mortality. HIV exposure accounted for an estimated 54% of all 24-month mortality in Botswana.

“With the growing success of prevention of mother-to-child transmission programs in preventing pediatric HIV-infection, our study highlights the need to shift our focus to understanding why HIV-exposed but uninfected children have such high mortality and design interventions to decrease mortality in this group,” Zash said. – by David Costill

Reference:
Zash R, et al. Abstract 802. Presented at: Conference on Retroviruses and Opportunistic Infections; Feb. 22-25, 2016; Boston.

Disclosure: The researchers report no relevant financial disclosures.