Mortality among HIV‐Exposed Infants: The First and Final Frontier

Excessive childhood mortality in sub-Saharan Africa is a tragic and familiar story. In the 1970s, >20% of children in Africa died before reaching 5 years of age, a rate higher than that in any other region in the world. When the human immunodeficiency virus (HIV) epidemic hit in the 1980s and 1990s, infant mortality rates increased further in some of the worst-affected areas as mother-to-child transmission (MTCT) became an important component of the problem. After more than a decade of research, there are now several proven antiretroviral interventions available to reduce MTCT of HIV to low levels, even in the context of breast-feeding, and the most extensive of these interventions may achieve MTCT rates as low as 1% [1–8]. However, as we chip away at MTCT in research cohorts and start to apply new interventions in program situations, we must not lose sight of overall infant mortality. Forty-three percent of the worldwide mortality among those <5 years of age currently occurs in Africa [9].