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The objective was to examine whether maternal HIV disease stage during pregnancy and child malnutrition are associated with child mortality. The design used was a prospective cohort study in Tanzania. Indicators of disease stage were assessed for 939 HIV-infected women during pregnancy and at delivery and childrens anthropometric status was obtained at scheduled monthly clinic visits after delivery. Children were followed up for survival status until 24 months after birth. Advanced maternal HIV disease during pregnancy (CD4 count less than 350 vs. greater than of equal to 350 cells/mm3) was associated with increased risk of child mortality through 24 months of age (hazard ratio [HR] = 1.74 95% confidence interval [CI]: 1.32 to 2.30). CD4 count less than 350 cells/ mm3 was also associated with an increased risk of death among children who remained HIV-negative during follow-up (HR = 2.00 95% CI: 1.36 to 2.94). Low maternal hemoglobin concentration and child undernutrition were related to an increased risk of mortality in this cohort of children. Low maternal CD4 cell count during pregnancy is related to increased risk of mortality in children born to HIV-infected women. Care and treatment for HIV disease including highly active antiretroviral therapy to pregnant women could improve child survival. Prevention and treatment of undernutrition in children remain critical interventions in settings with high HIV prevalence. (authors)