Doctors in Malawi have reported that in the absence of antiretroviral therapy and prophylaxis against opportunistic infections, 90% of children born with HIV infection were dead within three years of birth, and less than 1% had survived to their third birthday without developing symptomatic illness.
The study, conducted at Queen Elizabeth Central Hospital in Blantyre, followed 689 children born to HIV-positive mothers who had participated in a study of birth canal cleansing as a means of preventing mother to child HIV transmission. 190 were HIV-positive. A control group of 119 children born to HIV-negative mothers were also followed.
Almost all children were immunized against measles, polio, tetanus, diptheria and pertussis, and also received the BCG vaccine at birth.
In comparison, European research has shown that only 18% of children had died after three years follow-up, and in the United States the probability that a child would survive to the age of five was 75% in the years prior to the introduction of HAART. In both these cases, children were followed from birth, whereas in the Malawi study children were followed from the age of six months, so the death rate reported in Malawi may be underestimated. The death rate may also be underestimated because nearly 20% of the children were lost to follow up, and those in the HIV-positive group were significantly more likely to be lost to follow up, as well as having low birth weight at baseline. Low birth weight, as well as being significantly more common in HIV-positive children, is also an independent predictor of death.
Maternal death and illness does not appear to have had a significant impact on infant survival in this study. Only 28 mothers died during the follow-up period, a lower rate than seen in other studies of the relationship between maternal and infant survival in Africa.
The authors conclude that control of symptomatic diarrhoea and chronic suppurative otitis media will substantially reduce HIV-related morbidity in HIV-infected children in Africa, even without pediatric HIV testing. However, deciding how to implement prophlaxis against opportunistic infections is more difficult, because of the lack of detailed information about the incidence of different infections.
In this study, the major opportunistic infections in HIV-infected children were oral thrush, dermatitis and chest infections, and these were significantly more common amongst HIV-infected children. Developmental delay was also more common in HIV-infected children.
Reference
Taha, TE, Graham SM, Kumwenda NI, et al. Morbidity among human immunodeficiency virus-1 infected and uninfected African children. Pediatrics 106 (6), 2000.