Abstract

WEPE178 - Poster Exhibition

Morbidity and mortality among HIV-1-exposed uninfected infants enrolled in the breastfeeding, antiretrovirals and nutrition (BAN) trial in Malawi

J.B. Wiener¹, D. Kayira², C. Chasela², C.C. King¹, S.R. Ellington¹, M. Hosseinipour³, D.J. Jamieson¹, C. van der Horst⁴, A.P. Kourtis¹, BAN Study Team

¹U.S. Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, United States, ²UNC Project-Malawi, Lilongwe, Malawi, ³University of North Carolina School of Medicine, Division of Infectious Diseases, Lilongwe, Malawi, ⁴University of North Carolina School of Medicine, Division of Infectious Diseases, Chapel Hill, United States

Background: The BAN trial in Lilongwe, Malawi, randomized 2369 HIV-infected women with CD4 counts > 250 cells/µl and their infants to maternal, infant or no extended antiretroviral prophylaxis during breastfeeding. Women were counseled to breastfeed exclusively for 24 weeks, weaned over 4 weeks, and followed until 48 weeks; infants received a weaning supplement. We evaluated severe (Grade 3/4) morbidity and mortality in HIV-exposed uninfected infants enrolled in the BAN trial. Infant prophylactic cotrimoxazole was started at 6 weeks of age midway through the trial.
Methods: The morbidity outcomes examined were pneumonia/sepsis, diarrhea/growth faltering, and malaria. Neonatal deaths occurred within 30 days of life, and post-neonatal between 31 days and 48 weeks. Cox proportional hazards models were used to evaluate the effect of different factors on infant morbidity and mortality outcomes.
Results: The rate of pneumonia/sepsis was highest in the first 12 weeks of life before rapidly decreasing. Rates of all morbidity outcomes increased after 24 weeks postpartum. Prophylactic cotrimoxazole to the infant significantly decreased the rates of all morbidity outcomes. Rates of pneumonia/sepsis and diarrhea/growth faltering were higher during the rainy season (p< 0.01). Infants with low white blood cell count at birth had higher rates of diarrhea/growth faltering (p=0.02) and malaria (p=0.01). The strongest predictors of neonatal death were low birth weight (p< 0.001) and low platelet count at birth (p=0.01). The strongest predictors of post-neonatal death were rainy season (p=0.002), no infant cotrimoxazole (p=0.03), and low infant white blood cell count at birth (p=0.02).
Conclusions: Infant morbidity rates increased after 24 weeks postpartum when mothers started weaning. Introduction of prophylactic cotrimoxazole was associated with reduced rates of morbidity and mortality in HIV-1 exposed uninfected infants. Unexpectedly, a low white cell count at birth was a significant predictor of later serious infant morbidity and mortality in this cohort of HIV-uninfected African infants.