Opportunistic and Other Infections in HIV-Infected Children in Latin America Compared to a Similar Cohort in the United States

Abstract

Opportunistic and other infections have declined since the introduction of highly active antiretroviral therapy (HAART) in developed countries but few studies have addressed the impact of HAART in HIV-infected children from developing countries. This study examines the prevalence and incidence of opportunistic and other infections in Latin America during the HAART era. Vertically HIV-infected children enrolled in a cohort study between 2002 and 2007 were followed for the occurrence of 29 targeted infections. Cross-sectional and longitudinal analyses were performed to calculate the prevalence of infections before enrollment and the incidence rates of opportunistic and other infections after enrollment. Comparisons were made with data from a U.S. cohort (PACTG 219C). Of the 731 vertically HIV-infected children 568 (78%) had at least one opportunistic or other infection prior to enrollment. The most prevalent infections were bacterial pneumonia, oral candidiasis, varicella, tuberculosis, herpes zoster, and Pneumocystis jiroveci pneumonia. After enrollment, the overall incidence was 23.5 per 100 person-years; the most common infections (per 100 person-years) were bacterial pneumonia (7.8), varicella (3.0), dermatophyte infections (2.9), herpes simplex (2.5), and herpes zoster (1.8). All of these incidence rates were higher than those reported in PACTG 219C. The types and relative distribution of infections among HIV-infected children in Latin America in this study are similar to those seen in the United States but the incidence rates are higher. Further research is necessary to determine the reasons for these higher rates.

Antiviral Resistance and Correlates of Virologic Failure in the first Cohort of HIV-Infected Children Gaining Access to Structured Antiretroviral Therapy in Lima, Peru: A Cross-Sectional Analysis

“…In agreement with studies in industrialized countries [36,37], these findings indicate that the percentage of CD4 cells in children with HIV/AIDS (i.e. the immunologic category) could be used to guide treatment initiation.…”

Incidence of tuberculosis in children on antiretroviral therapy: a retrospective cohort study

“…On the other hand, TB incidence rate of this study was higher than that of a study conducted in Latin America [16], UK and Ireland [32], and China [20]. This variation might be due to the fact that the incidence rate of TB was low in the general population of high-income countries.…”

“…The “End TB” strategy has also set to stop TB epidemic through a process of reducing the number of TB deaths per year, TB incidence rate per year, and the catastrophic TB costs [8]. Initiation of antiretroviral therapy (ART) [9–14], cotrimoxazole prophylaxis therapy (CPT) [15], isoniazid prophylaxis therapy (IPT) [16–18], chemotherapy, tuberculosis vaccine, and early diagnosis [19] are help to prevent active TB infection in children.…”

“…Notably, 0.28 per 100 person-years reported in Latin America [16], 0.83 in China [20], 4.0 in South Africa [21], and 17.4 in East Africa [22]. …”

Exuberant Varicella-Zoster Exanthema and Pneumonia as Clinical Clue for HIV Infection

“…Blood cultures were negative as well as gastric aspirate testing for Mycobacterium tuberculosis. [1][2][3][4] Pneumonia rarely complicates varicella-zoster infection in immunocompetent children and should be a signal for immunodeficiency. A negative maternal HIV test performed at delivery does not exclude the possibility of motherto-child transmission because the mother may have been infected close to or after the delivery.…”