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

• Published in: Tropical medicine & international health 2016-06, Vol.21 (6), p.720-734
• Main Authors: Arikawa, Shino, Rollins, Nigel, Newell, Marie‐Louise, Becquet, Renaud
• Format: Article
• Language: English
• Subjects: Anti-HIV Agents - therapeutic use; Antiretroviral drugs; child; enfant; facteur de risque; factores de riesgo; Female; HIV; HIV Infections - drug therapy; HIV Infections - prevention & control; Human immunodeficiency virus; Humans; Infant; Infant Health; Infant Mortality; Infectious Disease Transmission, Vertical - prevention & control; lactantes; Maternal Health; Meta-analysis; meta‐análisis; Mortalidad; Mortality; Mortalité; méta‐analyse; niños; nourrisson; Pregnancy; Pregnancy Complications, Infectious - drug therapy; Reviews; risk factor; Risk Factors; Systematic Review; VIH
• ISSN: 1360-2276; 1365-3156
• DOI: 10.1111/tmi.12695

Objective With increasing maternal antiretroviral treatment (ART), the number of children newly infected with HIV has declined. However, the possible increased mortality in the large number of HIV‐exposed, uninfected (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 HIV‐unexposed, uninfected (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 A total of 14 studies were included in the meta‐analysis and 13 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 (four 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 (four studies) and 2.4 (95% CI: 1.1–5.1; I2 = 93%) at 24 months (three 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 characterise the impact of maternal death and breastfeeding on the survival of HEU infants in the context of maternal ART, where current evidence is limited. Objectif Avec l'augmentation du traitement antirétroviral (ART) maternel, le nombre d'enfants nouvellement infectés par le VIH a diminué. Cependant, la possible augmentation de la mortalité parmi le grand nombre d'enfants exposés au VIH, mais non infectés peut être préoccupante. Nous avons quantifié les risques de mortalité chez les enfants exposés, non infectés et examiné les facteurs associés. Méthodes Recherche systématique dans les bases de données électroniques (PubMed, Scopus). Nous avons inclus toutes les études faisant état de la mortalité des enfants exposés, non infectés jusqu’à l’âge de 60 mois et les facteurs associés. Le risque relatif de mortalité entre les enfants exposés non inecftés et les enfants non exposés, non infectés par le VIH a été extrait