Objective: To ascertain the pattern of symptomatic HIV infections, HIV seropositivity and mother to child transmission (MTCT) rate during a two-year follow up period at 6, 12, 18, and 24 months according to mothers serostatus during pregnancy.
Design: A longitudinal cohort study with socio-economic, medical, and demographic history of all participating pregnant women from recruitment; and of the child at birth recorded separately on pre-constructed questionnaire. The medical condition of each infant was recorded at the periodic follow-ups.
Setting: The maternal and paediatric wards of the Harare Central Hospital, Harare, Zimbabwe.
Subjects: Three hundred and eighty six HIV-seropositive and 372 HIV-seronegative Zimbabwean pregnant women attending maternal and paediatric wards of Harare Central Hospital.
Interventions: About 10 ml of umbilical (venous) blood was collected at birth, centrifuged after clotting and stored frozen until HIV tests were carried out. Also capillary blood for filter paper storage was taken at six and 16 months and venous blood at one and two years of age for HIV serology, using ELISA. HIV serostatus was confirmed using Western Blot (WB) technique.
Main outcome measures: The HIV-serostatus of participating pregnant women and of infants at birth, patterns of symptomatic HIV infections and HIV seropositivity among infants and the number of deaths during a two year follow up at periodic intervals.
Results: A total of 108 infant deaths occurred within the follow up period. Significantly more deaths (82 versus 25, p < 0.0001; excluding one infant whose HIV serostatus was not determined), parotitis, palpable neck and groin lymph nodes occurred among infants born to HIV positive than those born to HIV negative mothers. Palpable axillary lymph nodes were significantly more common at 12, 18, and 24 months of follow up in infants born to HIV positive women. The maternal HIV serostatus during pregnancy and of infants at all periodic follow ups showed no association with persistent diarrhoea, fever and cough. However prolonged fever became significantly associated at 24 months.
Conclusion: Mother to child transmission (MTCT) rate based on the HIV-serostatus of 272 infants; 17.4% in utero and 11.1% via breast milk respectively. Multivariate analysis showed that an infant presenting with faltering growth (Odds Ratio [OR] = 5.597), palpable neck (OR = 5.919) and axillary lymph nodes (OR = 4.197) was likely to be HIV positive at 24 months.