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Mortality risk and associated factors in HIV-exposed, uninfected children

Mortality risk and associated factors in HIV-exposed, uninfected children
Mortality risk and associated factors in HIV-exposed, uninfected children
Objective: Although with increasing maternal ART, the number of children newly infected with HIV has declined, possible increased mortality in the large number of HEU children may be of concern. We quantified mortality risks among HEU children and reviewed associated factors.

Methods: Systematic search of electronic databases (PubMed, Scopus). We included all studies reporting mortality of HEU children to age 60 months and associated factors. Relative risk of mortality between HEU and HUU children was extracted where relevant. Inverse variance methods were used to adjust for study size. Random-effects models were fitted to obtain pooled estimates.

Results: Fourteen studies were included in the meta-analysis and thirteen in the review of associated factors. The pooled cumulative mortality in HEU children was 5.5% (95% CI: 4.0-7.2; I2=?94%) at 12 months (11 studies) and 11.0% (95% CI: 7.6-15.0; I2?=?93%) at 24 months (4 studies). The pooled risk ratios for the mortality in HEU children compared to HUU children in the same setting were 1.9 (95% CI: 0.9-3.8; I2=?93%) at 12 months (4 studies) and 2.4 (95% CI: 1.1-5.1; I2=?93%) at 24 months (3 studies).

Conclusion: Compared to HUU children, mortality risk in HEU children was about double at both age points, although the association was not statistically significant at 12 months. Interpretation of the pooled estimates is confounded by considerable heterogeneity between studies. Further research is needed to inform the impact of maternal death and breastfeeding on the survival of HEU infants in the context of maternal ART, where current evidence is limited.
HIV, mortality, infant, child, risk factor, meta-analysis
1360-2276
720-734
Arikawa, Shino
2fc5ae2a-6696-402b-be33-621186e08cef
Rollins, Nigel
79b9cfdb-4a6b-44c1-89d9-dbe948a09167
Newell, Marie-Louise
c6ff99dd-c23b-4fef-a846-a221fe2522b3
Becquet, Renaud
2a9d5455-0233-4193-854c-21d3254efa40
Arikawa, Shino
2fc5ae2a-6696-402b-be33-621186e08cef
Rollins, Nigel
79b9cfdb-4a6b-44c1-89d9-dbe948a09167
Newell, Marie-Louise
c6ff99dd-c23b-4fef-a846-a221fe2522b3
Becquet, Renaud
2a9d5455-0233-4193-854c-21d3254efa40

Arikawa, Shino, Rollins, Nigel, Newell, Marie-Louise and Becquet, Renaud (2016) Mortality risk and associated factors in HIV-exposed, uninfected children. Tropical Medicine & International Health, 21 (6), 720-734. (doi:10.1111/tmi.12695). (PMID:27091659)

Record type: Article

Abstract

Objective: Although with increasing maternal ART, the number of children newly infected with HIV has declined, possible increased mortality in the large number of HEU children may be of concern. We quantified mortality risks among HEU children and reviewed associated factors.

Methods: Systematic search of electronic databases (PubMed, Scopus). We included all studies reporting mortality of HEU children to age 60 months and associated factors. Relative risk of mortality between HEU and HUU children was extracted where relevant. Inverse variance methods were used to adjust for study size. Random-effects models were fitted to obtain pooled estimates.

Results: Fourteen studies were included in the meta-analysis and thirteen in the review of associated factors. The pooled cumulative mortality in HEU children was 5.5% (95% CI: 4.0-7.2; I2=?94%) at 12 months (11 studies) and 11.0% (95% CI: 7.6-15.0; I2?=?93%) at 24 months (4 studies). The pooled risk ratios for the mortality in HEU children compared to HUU children in the same setting were 1.9 (95% CI: 0.9-3.8; I2=?93%) at 12 months (4 studies) and 2.4 (95% CI: 1.1-5.1; I2=?93%) at 24 months (3 studies).

Conclusion: Compared to HUU children, mortality risk in HEU children was about double at both age points, although the association was not statistically significant at 12 months. Interpretation of the pooled estimates is confounded by considerable heterogeneity between studies. Further research is needed to inform the impact of maternal death and breastfeeding on the survival of HEU infants in the context of maternal ART, where current evidence is limited.

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More information

Accepted/In Press date: 17 March 2016
e-pub ahead of print date: 19 April 2016
Published date: 6 June 2016
Keywords: HIV, mortality, infant, child, risk factor, meta-analysis
Organisations: Faculty of Medicine

Identifiers

Local EPrints ID: 393829
URI: http://eprints.soton.ac.uk/id/eprint/393829
ISSN: 1360-2276
PURE UUID: 1fe44c89-ce85-4dd5-ab74-4aa38fea0266
ORCID for Marie-Louise Newell: ORCID iD orcid.org/0000-0002-1074-7699

Catalogue record

Date deposited: 06 May 2016 09:42
Last modified: 13 Feb 2020 05:01

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Contributors

Author: Shino Arikawa
Author: Nigel Rollins
Author: Renaud Becquet

University divisions

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