Objective: The aim of this study was to investigate clinical risk factors on survival among infected children born to HIV-positive mothers in the southern region of Thailand. Methods: Data from routine prospective cohort studies from 1990–2010 were analyzed. In these studies, totally 1549 infected children born to HIV-positive mothers were enrolled at birth and followed longitudinally. Information on demographic, clinical manifestation, HIV infection status factors was collected. Survival analysis was used to determine risk factors associated with mortality. Results: The main result found that one-quarter of infected children died (434, 28.02%) during the follow-up period. A total of 135,295 person-months of follow up was available. The incident rate was 1.03 times per 100 person-months (95% CI: 0.97 to 1.08). The median survival time among infected children born to HIV-positive mothers from diagnosis to death was 87.34 months (95% CI: 87.32 to 87.36). Infected children born to HIV-infected mothers were diagnosed to confirm as AIDS (88.44%) and symptomatic HIV positive (11.56%), respectively. Regarding the clinical risk factor on survival among infected children born to HIV-positive mothers were found. Infected children born to HIV-positive mothers were more likely to die, who infected with candidiasis (HR: 1.47, 95% CI: 1.07 to 2.00), Mycobacterium tuberculosis (HR: 1.51, 95% CI: 1.26 to 1.81) and Pneumocystis carinii (HR: 1.50, 95% CI: 1.27 to 1.76), those compared to infected children without clinical manifestation. Conclusion: Mortality among infected children born to HIV-positive mothers contributed to high levels in the southern region of Thailand. Consequently, health service system related to prevent mother-to-child HIV transmission is needed to improve child survival by lowering HIV infection and mortality in children born to HIV-positive mothers
