Background: Assumptions about survival of HIV-infected children in Africa without antiretroviral therapy need to be\nupdated to inform ongoing UNAIDS modelling of paediatric HIV epidemics among children. Improved estimates of infant\nsurvival by timing of HIV-infection (perinatally or postnatally) are thus needed.\nMethodology/Principal Findings: A pooled analysis was conducted of individual data of all available intervention cohorts and\nrandomized trials on prevention of HIV mother-to-child transmission in Africa. Studies were right-censored at the time of infant\nantiretroviral initiation. Overall mortality rate per 1000 child-years of follow-up was calculated by selected maternal and infant\ncharacteristics. The Kaplan-Meier method was used to estimate survival curves by childââ?¬â?¢s HIV infection status and timing of HIV\ninfection. Individual data from 12 studies were pooled, with 12,112 children of HIV-infected women. Mortality rates per 1,000\nchild-years follow-up were 39.3 and 381.6 for HIV-uninfected and infected children respectively. One year after acquisition of\nHIV infection, an estimated 26% postnatally and 52% perinatally infected children would have died; and 4% uninfected\nchildren by age 1 year. Mortality was independently associated with maternal death (adjusted hazard ratio 2.2, 95%CI 1.6ââ?¬â??3.0),\nmaternal CD4,350 cells/ml (1.4, 1.1ââ?¬â??1.7), postnatal (3.1, 2.1ââ?¬â??4.1) or peri-partum HIV-infection (12.4, 10.1ââ?¬â??15.3).\nConclusions/Results: These results update previous work and inform future UNAIDS modelling by providing survival\nestimates for HIV-infected untreated African children by timing of infection. We highlight the urgent need for the\nprevention of peri-partum and postnatal transmission and timely assessment of HIV infection in infants to initiate\nantiretroviral care and support for HIV-infected children.
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