MORTALITY IN HIV-1-SEROPOSITIVE WOMEN, THEIR SPOUSES AND THEIR NEWLY BORN CHILDREN DURING 36 MONTHS OF FOLLOW-UP IN KINSHASA, ZAIRE

Objective: To calculate 3-year mortality rates in HIV-l-seropositive and HIV-1-seronegative mothers, their newborn children and the fathers of these children. Design: Longitudinal cohort study of HIV-1-seropositive, age and parity-matched HIV-1-seronegative pregnant women, their newborn babies and the fathers of these children. Setting: Obstetric ward and follow-up clinic at a large municipal hospital in Kinshasa, Zaire. Participants: A total of 335 newborn children and their 327 HIV-1-seropositive mothers and 341 newborn children and their 337 HIV-1-seronegative mothers and the fathers of these children. Main outcome measures: Rates of vertical HIV-1 transmission and maternal, paternal and early childhood mortality. Results: The lower and upper bounds of vertical transmission were 27 and 50%, respectively. The 3-year mortality rate was 44% in children with vertically acquired HIV-1 infection, 25% in children with HIV-1-seropositive mothers and indeterminant HIV-1 infection status, and 6% in uninfected children with HIV-1-seronegative mothers. HIV-1-seropositive women who transmitted HIV-1 infection to their most recently born child had lost a greater number of previously born children (mean, 1.5 versus 0.5; P< 0.05), were more likely to have had AIDS at delivery (25 versus 12%; P< 0.01) and were more likely to die during follow-up (22 versus 9%; P<0.01) than HIV-1-seropositive women who did not transmit HIV-1 infection to their newborn child. Twenty-five out of 239 (10.4%) fathers of children with HIV-1-seropositive mothers, not lost to follow-up, died compared with three out of 310 (1%) fathers of children with HIV-1-seronegative mothers (P< 0.01). Conclusions: Families in Kinshasa, Zaire, in which the mother was HIV-1-seropositive experienced a five to 10-fold higher maternal, paternal and early childhood mortality rate than families in which the mother was HIV-1-seronegative.