Treating HIV-infected mothers reduces under 5 years of age mortality rates to levels seen in children of HIV-uninfected mothers in rural South Africa.

Abstract

Maternal and child survival are highly correlated, but the contribution of HIV infection on this relationship, and in particular the effect of HIV treatment, has not been quantified. We estimate the association between maternal HIV and treatment, and under 5 years of age (under-5) child mortality in a rural population in South Africa. All children born between January 2000 and January 2007 in the Africa Centre Demographic Surveillance Area were included. Maternal HIV status information was available from HIV surveillance; maternal antiretroviral treatment (ART) information from the HIV Treatment Programme database was linked to surveillance data. Mortality rates were computed as deaths per 1,000 person-years observed. Time-varying maternal HIV effect (positive, negative, ART) on under-5 mortality was assessed in Cox regression, adjusting for other factors associated with under-5 mortality. In total, 9,068 mothers delivered 12,052 children, of whom 947 (7.9%) died before age 5. Infant mortality rate declined by 49% from 69.0 in 2000 to 35.5 in 2006 deaths per 1,000 person-years observed; a significant decline was observed post-ART (2004-2006). The estimated proportion of deaths across all age groups were higher among the children born to the HIV-positive and HIV-not-reported status women than among children of HIV-negative women. Multivariably, mortality in children of mothers on ART was not significantly different from children of HIV-negative mothers (adjusted hazard ratio 1.29, 0.53-3.17; P=0.572). These findings highlight the importance of maternal HIV treatment with direct benefits of improved survival among all children under-5. Timely HIV treatment for eligible women is required to benefit both mothers and children.