Highly prevalent mother to child HIV transmission has given rise to pediatric AIDS mortality, especially in countries where resources are few. It has been difficult to follow up HIV exposed infants, so that timely diagnosis of HIV infection can be made which results in appropriate treatment, care and support. Several studies have reported short term survival of HIV exposed children from vertical transmission [1-4]. The substantial interest in PMTCT has generated information on short term survival of vertically infected children both in the pre Highly Active Antiretroviral Therapy (HAART) and post HAART era particularly in developed countries [3-6]. On the other hand, there is very little information on long-term survival of these children in resource poor settings where follow up is a challenge. Child mortality is independently associated with maternal HIV status and maternal death, with pediatric infection resulting in approximately a four fold increase in mortality by the age of two years compare to HIV unexposed infants [7]. To determine the proportion of children whose mothers had enrolled in the Better Health for the African Mother and Child cohort and were surviving at 5 years of age, a cross sectional study of HIV infected children was carried out between 2007 and 2008 prior to universal access of antiretroviral drugs in Zimbabwe.

The study was conducted at three primary maternal child health clinics in peri-urban areas around Harare (namely Epworth, Seke North and St Mary’s) in Zimbabwe.

The initial study was a cohort study of HIV infected pregnant women who had been enrolled in a PMTCT program between 2002 and 2003. The follow up of mothers and children occurred up until 15 months of post natal age and ceased. We describe cross-sectional characteristics of HIV exposed children after a five year follow up visit.

The pregnant women were enrolled into the cohort study from 36 weeks of gestation, after obtaining informed consent. The aim of the initial study was to explore the role of sexually transmitted infections in pregnancy outcome. Pre and post HIV test counseling were offered as part of the national PMTCT program. Baseline characteristics collected included sociodemographic information, medical history of sexually transmitted infections, gynecological examination findings and specimen collection for full blood counts, serology for herpes simplex type 2 and syphilis, and high vaginal swabs for culture. All HIV infected women were given a single dose of nevirapine at delivery; their infants received a single dose of nevirapine, according to the national guidelines at that time (HIVNET 012) [8]. The infants were then followed up at 6weeks, 4 months, 9 months and 15 months and HIV status determined by HIV DNA PCR (Roche Diagnostics, Indianapolis, USA) if the children were aged less than 15 months, and rapid HIV antibody tests, Determine (Abbott Diagnostics, Illinois, USA) and Oraquick (abbott before 15 months and antibody tests at 15 months. The proportion of HIV infected infants has been reported [9].

At the 5 year follow up visit, HIV infected women who had been enrolled in the BHMAC study were identified from registers and traced to their homes where information on survival of their children was collected. HIV infected children were also identified from pediatric follow up clinics and blood was collected for CD4 counts.

Figure 1 shows the follow up of HIV infected infants born from the recruited mothers, 27 out of 93 (29%) HIV infected children survived. There were no significant differences in maternal baseline characteristics, notably haemoglobin p = 0.563, total lymphocyte count p = 0.557, age p = 0.067 and disclosure of HIV status to partner p = 0.733 between the 204 children who were lost before HIV diagnosis and those tested for HIV. Table 1 shows unadjusted hazard ratios for predictors of child mortality. Breast feeding at 4 months was protective of death p = 0.002, which is reflected at 6 weeks and 9 months but not statistically significant. We were able to postulate causes of mortality by verbal autopsy in 27 patients. Of these, 13 (48%) died from pneumonia, 13 (48%) from diarrhea and 1 (4%) from asthma.