Women's morbidity and mortality in the first 2 years after delivery according to HIV status.

BACKGROUND: Better knowledge of the impact of HIV status on morbidity and mortality patterns of women after delivery is important to improve clinical and policy recommendations.
METHODS: Women were enrolled during pregnancy in the Vertical Transmission Study, prior to antiretroviral roll-out in South Africa, and followed for 24 months after delivery. Their health was evaluated by standardized questionnaires and clinical examinations.
RESULTS: Information was available for 2624 women, 50.5% of whom were HIV-infected. Mortality was 8.6 deaths per 1000 person-years in HIV-uninfected, and 55.68 in HIV-infected women. Mortality was associated with antenatal CD4 cell count in HIV-infected women: 171.43/1000 person-years in those with CD4 cell count below 200 compared to 19.35/1000 in those with CD4 cell count at least 200. There was no significant difference between the intensity of breastfeeding during the first 3 months after delivery in women who died and those who survived, regardless of mother's HIV infection status (P = 0.112 and P = 0.530, respectively). Serious morbidity events were documented in 250 of 2624 (9.5%) women; the most common events were bloody diarrhoea (26.4%), pulmonary tuberculosis (24.4%) and an abscess (17.2%). Multivariable Cox regression analysis identified HIV infection, lower levels of education, river/stream water source as risk factors.
CONCLUSION: HIV-infected women experienced more morbidity and mortality than HIV-uninfected women; this was predicted by maternal immune status and socio-economic factors. HIV-infected women even in the high CD4 strata had higher mortality than HIV-uninfected women from the same population. This study underlines the importance of interventions to improve maternal health, for example timely antiretroviral treatment, tuberculosis screening, and improved water and sanitation.