Background: To determine trends in mortality among Zambian mother-infant pairs (MIP) where the mother was either dually infected with both HIV-1 and HHV-8, infected with either HHV-8 or HIV-1 alone, or not infected with either virus.

Methods: Prospective, longitudinal study of Zambian MIP classified into 4 separate cohorts according to the mother’s serological profile as follows; Group 1: HIV-1⁺ and HHV-8⁺, Group 2: HIV-1^-, HHV-8⁺, Group 3: HIV-1⁺, HHV-8^-, and Group 4: HIV-1^-, HHV-8^-. Mortality was recorded for all infants in each group. Statistical analysis of differences in mortality among the 4 cohorts was performed using EPI info version 6 and STATISTIX-7 to do Kaplan-Meier survival analyses. HHV8 infection status was determined by IFA and EIA; HIV infection status was determined by 2 rapid tests, the first a screening test, the second confirmatory.

Results: Between 9/98–5/01, 1,431 MIP were followed prospectively as members of 4 separate groups: Grp1 221 (15.5%), Grp2 472 (33.1%), Grp3 291 (20.6%), and Grp4 438 (30.7%). HIV-1 and HHV-8 seroprevalences overall were 36.0% and 48.7% respectively. After 36 months of follow-up, 112 infants had died (overall crude mortality rate [CMR] 78.8 deaths per 1000 births). Group specific CMR among infants were as follows: Grp1 208/1000, Grp2 33.9/1000, Grp3 140.9/1000, and Grp4 20.5/1000 (Grp1 versus Grp 4, p < 0.05; Grp 3 versus Grp 4, p < 0.04 Chi square analysis). Kaplan Meier analysis (See Figure) documented a higher CMR among infants in Grp 1 and Grp 3 versus Grp 4, and a trend towards a higher CMR among Grp 1 as opposed to Grp 3. Respiratory tract infections and gastroenteritis were the most common causes of infant death. Sixteen (16) mothers died; only 1 of whom was not infected (not with HIV-1 or HHV-8).

Conclusion: The highest CMR among infants occurred among infants born to dually infected mothers. The rate in this group was 10 times the background rate in Grp 4; > 6 times the CMR in Grp 2, and 1.5 times higher than the rate in Grp 3.