Incidence of Opportunistic and Other Infections in HIV-Infected Children in the HAART Era

Gona, Philimon; Dyke, Russell B. Van; Williams, Paige L.; Dankner, Wayne M.; Chernoff, Miriam; Nachman, Sharon; Seage, George R.

doi:10.1001/jama.296.3.292

Cited by 243 publications

(212 citation statements)

References 17 publications

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“…In our study cryptosporidiosis was significantly reduced (more than five times), as observed in other studies [11,29]. For other diseases (excluding cryptococcosis), despite the indication of reduction in the proportion of cases in the second period, there was not a significant difference between the periods.…”

Section: Discussionsupporting

confidence: 84%

“…However, few population-based studies have evaluated changes in the pattern of occurrence of diseases associated with HIV/AIDS [11,18,28,29]. Our data show a significant reduction in occurrence of all opportunistic illness in the HAART era: children that were born, or diagnosed with HIV/AIDS or had ART initiation after 1996 consistently and significantly reducing the chances of having opportunistic illness.…”

Section: Discussionmentioning

confidence: 65%

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Opportunistic illnesses in Brazilian children with AIDS: results from two national cohort studies, 1983-2007

Ramos

Matida²,

Hearst

et al. 2011

AIDS Res Ther

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BackgroundHAART has significantly reduced AIDS-related morbidity in children. However, limited evidence is available from developing countries regarding patterns of opportunistic illnesses. We describe these events and their associated factors in children with AIDS in Brazil.MethodsThis study is based on two representative retrospective multi-center cohorts including a total 1,859 children with AIDS, infected via mother-to-child transmission (MTCT), between 1983-2002. Opportunistic illnesses were described and analyzed over time. The association of demographic, clinical and operational data with the occurrence of opportunistic diseases was assessed.ResultsIn total, 1,218 (65.5%) had at least one event of an opportunistic disease. Variables significantly associated with occurrence of these events included: region of residence (OR 2.68-11.33, as compared to the Northern region), age < 1 year at diagnosis (OR 2.56, 95% CI 1.81-3.61, p < 0.001), and non-performance of MTCT prevention measures (OR 1.58, 95% CI 1.21-2.07, p < 0.001). Protective factors included year of HIV diagnosis in the HAART era (OR 0.34, 95% CI 0.15-0.76, p = 0.009) and ART use (OR 0.58, 95% CI 0.44-0.77, p < 0.001). In both periods bacterial infections represented the most common opportunistic events (58.6 vs. 34.7%; p < 0.001), followed by Pneumocystis jirovecii pneumonia (21.9 vs. 13.2%; p < 0.001), and bacterial meningitis/sepsis (16.8 vs. 7.4%; p < 0.001).ConclusionsDespite the significant reduction in recent years, opportunistic illnesses are still common in Brazilian children with AIDS in the HAART era, especially bacterial diseases. The data reinforce the need for scaling up prevention of MTCT, early diagnosis of infection, and improvement of comprehensive pediatric care.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 65%

Opportunistic illnesses in Brazilian children with AIDS: results from two national cohort studies, 1983-2007

Ramos

Matida²,

Hearst

et al. 2011

AIDS Res Ther

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“…[6][7][8][9] Pre-HAART, bacterial pneumonia, pneumocystis pneumonia (PCP), disseminated Mycobacterium avium complex (MAC) and tracheobronchial candidiasis were the most frequent respiratory infections, Table 1. 6,9 Bacterial Pathogens S. pneumoniae is the most common cause of bacterial pneumonia in HIV-infected children [27][28][29] HIV-infected children may also frequently develop recurrent pneumococcal infections. 27-29 S aureus including methicillinresistant strains is an increasingly important cause of pneumonia in HIV-infected children.…”

Section: Pulmonary Infectionsmentioning

confidence: 99%

“…7 The use of HAART dramatically reduces the incidence of NTM disease in children; in the USA this declined from a rate of 1.8 per 100 child-years pre-HAART to 0.1 post-HAART, Table 1. 6,9 Treatment of MAC involves combination therapy with a minimum of two drugs, as monotherapy with a macrolide leads rapidly to resistance. 7 Initial recommended therapy is clarithromycin or azithromycin plus ethmabutol.…”

Section: Mycobacterial Infectionsmentioning

confidence: 99%

“…5 With improved survival of HIV-infected children, the incidence of acute respiratory infections and opportunistic respiratory infections has declined while HIV-associated chronic lung disease has increasingly emerged. [6][7][8][9] This review will focus on the spectrum, diagnosis and management of chronic lung disease in HIV-infected children.…”

Section: Introductionmentioning

confidence: 99%

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Chronic lung disease in human immunodeficiency virus (HIV) infected children

Zar

2007

Pediatric Pulmonology

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The development of chronic lung disease is common in HIV‐infected children. The spectrum of chronic HIV‐associated lung disease includes lymphocytic interstitial pneumonia (LIP), chronic infections, immune reconstitution inflammatory syndrome (IRIS), bronchiectasis, malignancies, and interstitial pneumonitis. Chronic lung disease may result from recurrent or persistent pneumonia due to bacterial, mycobacterial, viral, fungal or mixed infections. In high tuberculosis (TB) prevalence areas, M. tuberculosis is an important cause of chronic respiratory illness. With increasing availability of highly active antiretroviral therapy (HAART) for children in developing countries, a rise in the incidence of IRIS due to mycobacterial or other infections is being reported. Diagnosis of chronic lung disease is based on chronic symptoms and persistent chest X‐ray changes but definitive diagnosis can be difficult as clinical and radiological findings may be non‐specific. Distinguishing LIP from miliary TB remains a difficult challenge in HIV‐infected children living in high TB prevalence areas. Treatment includes therapy for specific infections, pulmonary clearance techniques, corticosteroids for children with LIP who are hypoxic or who have airway compression from tuberculous nodes and HAART. Children who are taking TB therapy and HAART need adjustments in their drug regimes to minimize drug interactions and ensure efficacy. Preventative strategies include immunization, chemoprophylaxis, and micronutrient supplementation. Early use of HAART may prevent the development of chronic lung disease. Pediatr Pulmonol. 2008; 43:1–10. © 2007 Wiley‐Liss, Inc.

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Incidence of Noninfectious Conditions in Perinatally HIV-Infected Children and Adolescents in The HAART Era

Nachman¹

2009

Arch Pediatr Adolesc Med

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Objective: To estimate highly active antiretroviral therapy (HAART)-era incident rates for the first episode of noninfectious conditions in human immunodeficiency virus (HIV)-infected youth in order to identify HAART-era changes in the natural history of perinatal HIV infection.Design: Multicenter prospective cohort study. Conclusions: Between 2001 and 2006, the incidence for 3 conditions decreased and increased for 2 others, demonstrating the change in medical issues and conditions in perinatally infected youth. Continued surveillance with appropriate tools will be needed to assess the long-term effects of HAART and HIV as well as development of new noninfectious conditions of HIV.

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Incidence of Opportunistic and Other Infections in HIV-Infected Children in the HAART Era

Cited by 243 publications

References 17 publications

Opportunistic illnesses in Brazilian children with AIDS: results from two national cohort studies, 1983-2007

Opportunistic illnesses in Brazilian children with AIDS: results from two national cohort studies, 1983-2007

Chronic lung disease in human immunodeficiency virus (HIV) infected children

Incidence of Noninfectious Conditions in Perinatally HIV-Infected Children and Adolescents in The HAART Era

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