Morbidity and mortality among infants born to HIV-infected women in South Africa: implications for child health in resource-limited settings.

BACKGROUND We examined correlates of infant morbidity and mortality within the first 3 months of life among HIV-exposed infants receiving post-exposure antiretroviral prophylaxis in South Africa. METHODS We conducted a prospective cohort study of 848 mother-child dyads. Multivariable Cox proportional hazards models were used. RESULTS The main causes of infant morbidity were gastrointestinal and respiratory infections. Morbidity was higher with infant HIV infection (HR: 2.61; 95% CI: 1.40-4.85; p = 0.002) and maternal plasma viral load (PVL) >100,000 copies ml⁻¹ (HR: 1.87; 95% CI: 1.01-3.48; p = 0.048), and lower with maternal age < 20 years (HR: 0.25; 95% CI: 0.07-0.88; p = 0.031). Mortality was higher with infant HIV infection (HR: 4.10; 95% CI: 1.18-14.31; p = 0.027) and maternal PVL >100,000 copies ml⁻¹ (HR: 6.93; 95% CI: 1.64-29.26; p = 0.008). Infant feeding status did not influence the risk of morbidity nor mortality. CONCLUSIONS Future interventions that minimize pediatric HIV infection and reduce maternal viremia, which are the main predictors of child health soon after birth, will impact positively on infant health outcomes.