Maternal health and infant mortality

Polly Clayden, HIV i-Base

A poster authored by Louise Kuhn and colleagues evaluated the effect of maternal HIV status on a group of uninfected infants born to HIV positive mothers in Lusaka, Zambia [1].

Due to MTCT programmes this group is increasing and although they are not infected themselves, mortality and morbidity among exposed, uninfected children is substantial in sub Saharan Africa.

The study asked the question: “Does HIV disease progression and immune dysfunction among HIV positive mothers increase the mortality and morbidity of their uninfected infants?”

The authors reported that among this group of 620 breast fed infants, at <4 months mortality was significantly associated with low maternal CD4 count <350 cells/mm3, (HR = 2.87, 95% CI 1.03 to 8.03) even after adjusting for maternal death (HR = 6.84, 95% CI 2.65 to17.70) and low birth weight (HR 2.43, 95% CI 1.05 to 5.65).

They write: “Uninfected infants born to immunosuppressed HIV-positive mothers appear to be at increased risk of mortality. This increase is not explained by the risks associated with separation because of maternal death or hospitalisation nor does it result from lower birth weight.”

They offer various possible explanations: diminished care giving capacity of an ill mother; the effect of interuterine viral exposure; the effect of maternal immunosuppression on the developing foetal immune system; maternal depression and nutritional deficiencies in breast milk

They raise the concern that infants born to HIV positive mothers are overlooked as a high risk population that may not benefit from treatment programmes. And conclude: “Better understanding of these processes are needed to identify interventions to address the needs of the hidden population of children affected by HIV.”

A poster from Glenda Gray’s group also included some maternal health data in an analysis that looked at the incidence of hospital admissions and deaths in both HIV-infected and uninfected infants, and factors that were associated with infant morbidity and mortality.

They found that maternal disease progression appears to negatively affect child survival in both negative and positive infants, in multivariate analysis maternal CD4 <200 cells/mm3 was a significant risk factor for infant mortality and morbidity (OR=1.5, 95% CI 1.1 to 2.5]. In their conclusion they state: “…child survival will improve by preventing maternal HIV infection and treating HIV infected mothers”.


More strong arguments for taking care of maternal health.


  1. Kuhn L, Kasonde P, Kankasa C et al. Not infected but still affected: prognosis of uninfected infants born to HIV+ mothers in Zambia. 12th CROI, Boston, 2005.
    Abstract 805.
  2. Gray G, Niekerk R, Urban M et al. Death and hospital admissions in infants born to HIV-infected women. 12th CROI, Abstract 803.

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