Observational studyBMC pediatrics2016
HIV-exposed children account for more than half of 24-month mortality in Botswana.
Observational study in BMC pediatrics, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
27 citing papers in PubMed.
- Immunologic and Virologic Factors Associated With Hospitalization in Human Immunodeficiency Virus-Exposed, Uninfected Infants in the United States.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2021Trial
- Trial
- Effect of maternal HIV status on the early neonatal microbiome.Journal of the Pediatric Infectious Diseases Society · 2025Article
- Reduced B cell frequencies in cord blood of HIV-exposed uninfected infants: an immunological and transcriptomic analysis.Frontiers in immunology · 2024Article
- No increased in utero and peripartum HIV acquisition risk in HIV-exposed preterm infants.Southern African journal of HIV medicine · 2023Article
- Severity of illness and mortality among children admitted to a tertiary referral hospital in Botswana: A secondary data analysis of a prospective cohort study.SAGE open medicine · 2023Article
- Association of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection With Maternal Mortality and Neonatal Birth Outcomes in Botswana by Human Immunodeficiency Virus Status.Obstetrics and gynecology · 2023Article
- Incidence of Mortality among Under-Five-Year-Old Children Born to Women Living with HIV and Those Born to Women Not Living with HIV in Botswana: A 5-Year Retrospective Study.AIDS research and treatment · 2022Article
- Are morbidity and mortality estimates from randomized controlled trials externally valid? A comparison of outcomes among infants enrolled into an RCT or a cohort study in Botswana.BMC medical research methodology · 2021Observational
- Lack of HIV RNA test result is a barrier to breastfeeding among women living with HIV in Botswana.International breastfeeding journal · 2021Article
- Factors Associated with Infant Feeding Choices Among Women with HIV in Botswana.Maternal and child health journal · 2021Article
- A Tale of 2 Pneumos: The Impact of Human Immunodeficiency Virus Exposure or Infection Status on Pediatric Nasopharyngeal Carriage of Streptococcus pneumoniae and Pneumocystis jiroveci: A Nested Case Control Analysis From the Pneumonia Etiology Research In Child Health Study.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2021Article
- Human Immunodeficiency Virus Exposure but Not Early Cytomegalovirus Infection Is Associated With Increased Hospitalization and Decreased Memory T-Cell Responses to Tetanus Vaccine.The Journal of infectious diseases · 2020Article
- Vitamin D status, nutrition and growth in HIV-infected mothers and HIV-exposed infants and children in Botswana.PloS one · 2020Article
- Peripheral blood mononuclear cell transcriptomes reveal an over-representation of down-regulated genes associated with immunity in HIV-exposed uninfected infants.Scientific reports · 2019Article
- Contemporary Issues in Pregnancy (and Offspring) in the Current HIV Era.Current HIV/AIDS reports · 2019Review
- Population-level Mortality Associated with HIV Exposure in HIV-uninfected Infants in Botswana and South Africa: A Model-based Evaluation.Journal of tropical pediatrics · 2019Article
- Article
- Investigating Mediators of the Poor Pneumonia Outcomes of Human Immunodeficiency Virus-Exposed but Uninfected Children.Journal of the Pediatric Infectious Diseases Society · 2019Article
- Progress in the performance of HIV early infant diagnosis services in Zambia using routinely collected data from 2006 to 2016.BMC public health · 2018Article
Corrections and comments
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Authors and funding
13 authors.
Funding
Abstract
backgroundThe contribution of HIV-exposure to childhood mortality in a setting with widespread antiretroviral treatment (ART) availability has not been determined.
methodsFrom January 2012 to March 2013, mothers were enrolled within 48 h of delivery at 5 government postpartum wards in Botswana. Participants were followed by phone 1-3 monthly for 24 months. Risk factors for 24-month survival were assessed by Cox proportional hazards modeling.
resultsThree thousand mothers (1499 HIV-infected) and their 3033 children (1515 HIV-exposed) were enrolled. During pregnancy 58 % received three-drug ART, 23 % received zidovudine alone, 11 % received no antiretrovirals (8 % unknown); 2.1 % of children were HIV-infected by 24 months. Vital status at 24 months was known for 3018 (99.5 %) children; 106 (3.5 %) died including 12 (38 %) HIV-infected, 70 (4.7 %) HIV-exposed uninfected, and 24 (1.6 %) HIV-unexposed. Risk factors for mortality were child HIV-infection (aHR 22.6, 95 % CI 10.7, 47.5 %), child HIV-exposure (aHR 2.7, 95 % CI 1.7, 4.5) and maternal death (aHR 8.9, 95 % CI 2.1, 37.1). Replacement feeding predicted mortality when modeled separately from HIV-exposure (aHR 2.3, 95 % CI 1.5, 3.6), but colinearity with HIV-exposure status precluded investigation of its independent effect. Applied at the population level (26 % maternal HIV prevalence), an estimated 52 % of child mortality occurs among HIV-exposed or HIV-infected children.
conclusionsIn a programmatic setting with high maternal HIV prevalence and widespread maternal and child ART availability, HIV-exposed and HIV-infected children still account for most deaths at 24 months. Lack of breastfeeding was a likely contributor to excess mortality among HIV-exposed children.
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