Mortality after the first year of life among human immunodeficiency virus type 1-infected and uninfected children

Background. HIV-infected and uninfected children who survived their first y ear of life were prospectively followed in Malawi to assess levels of morta lity and related risk factors during the second and third years of life. Methods. Children with known HIV status from an earlier perinatal intervent ion trial were enrolled. These children [HIV-infected (Group A); HIV-uninfe cted but born to HIV-seropositive mothers (Group B); and children born to H IV-seronegative mothers (Group C)] were followed every 3 months until age 3 6 months. Mortality data were collected at each visit. Immunologic data (CD 4(+) percent) were collected at or immediately after enrollment. Results. Overall 702 children were enrolled and 83 children died during fol low-up. The mortality rate per 1000 person years of observation was 339.3 a mong Group A children, 46.3 among Group B children and 35.7 among Group C c hildren. Among HIV-infected children the cumulative proportion surviving to age 24 months was 70% and those surviving to age 36 months was 55%. By age 32 months none of the severely immunosuppressed (CD4% < 15%) children had survived. The mortality differentials between HIV-infected and uninfected c hildren persisted after adjusting for several risk factors. The major cause s of death among infected children (n = 52) were wasting and respiratory co nditions. Conclusions. Although all HIV-infected children had received childhood immu nizations, mortality was high. Management of these children should include aggressive antimicrobial treatment, and evaluation of prophylactic regimens should be considered.