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.