Respiratory diseases in the first year of life in children born to HIV‐1‐infected women*

Abstract

Our objective was to describe the respiratory complications, clinical findings, and chest radiographic changes in the first year of life in infected and uninfected children born to HIV-1-infected women. We prospectively followed a cohort of 600 infants born to HIV-1-infected women from birth to 12 months in a multicenter study. Of these, 93 infants (15.5%) were HIV-1-infected, 463 were uninfected, and 44 were of unknown status prior to death or loss to follow-up. The cumulative incidence ( +/- SE) of an initial pneumonia episode at 12 months was 24.1 +/- 4.7% in HIV-1-infected children compared to 1.4 +/- 0.6% in HIV-1-uninfected children (P< 0.001). The rate of Pneumocystis carinii pneumonia (PCP) was 9.5 per 100 child-years. The HIV-1 RNA load was not higher in the group that developed pneumonia in the first year vs. those who did not. Children who developed lower respiratory tract infections or PCP had increased rates of decline of CD4 cell counts during the first 6 months of life. Lower maternal CD4 cell counts were associated with higher rates of pneumonia, and upper and lower respiratory tract infections. The rates of upper respiratory tract infection and bronchiolitis/reactive airway disease in infected children were not significantly different than in uninfected children. At 12 months, significantly more HIV-1-infected than uninfected children had tachypnea and chest radiographs with nodular and reticular densities. There was no relationship between cytomegalovirus infection in the first year of life and radiographic changes or occurrences of pneumonia. In conclusion, despite a low incidence of PCP, rates of pneumonia remain high in HIV-infected children in the first year of life. The incidence of pneumonia in uninfected infants born to HIV-1-infected mothers is low. Chest X-ray abnormalities and tachypnea suggest that subacute disease is present in infected infants. Further follow-up is warranted to determine its nature.

Systematic Review on the Etiology and Antibiotic Treatment of Pneumonia in Human Immunodeficiency Virus-infected Children

“…The majority of studies used WHO clinical criteria of lower respiratory tract infection in defining severe pneumonia, whereas 3 studies used varying definitions of radiographic evidence of pneumonia. 13,33,34 Most studies recruited only children fulfilling the WHO clinical criteria of severe pneumonia, whereas 2 studies were not explicit in this regard. 13,22 Additional differences between studies included control for potential confounding factors, control selection, for example, the control group in the study by were children with clinical suspicion of HIV disease but who subsequently tested negative for HIV, whereas any HIV-uninfected children served as controls in other comparative studies; differences in ascertainment of HIV infection status where HIV infection status was not consistently confirmed by HIV polymerase chain reaction testing in children younger than 15 months who were HIV seropositive; 22,23,[31][32][33]35 and differences in sampling sites from which pathogens were identified.…”

“…The studies involved children hospitalized with CAP, except for 2 cohort studies from the United States that included all physicianreported pneumonia episodes without stratifying by hospitalization status. 13,14 Nine studies were categorized as descriptive with enrollment limited to children who were known to be HIVinfected, including 7 antemortem (Table 3). There was high level of agreement (0.902) on the quality of the descriptive studies between the reviewers.…”

Maternal and Infant Factors Associated With Failure to Thrive in Children With Vertically Transmitted Human Immunodeficiency Virus-1 Infection: The Prospective, P2C2 Human Immunodeficiency Virus Multicenter Study

“…21 Specific criteria for viral and bacterial pneumonia diagnoses have been previously reported. 22 Evidence from bronchial lavage fluid or open lung biopsy was needed for a diagnosis of Pneumocystis carinii pneumonia (PCP). Mycobacterial infection was diagnosed when a new radiographic abnormality occurred and a culture from lower-airway secretions or an open lung biopsy specimen showed that the organism was present.…”

The health and social environment of uninfected infants born to HIV-infected women

“…Also, because we have information on uninfected infants born since 1985 in different European countries, we were able to report temporal and geographical trends in characteristics of this cohort over much of the HIV epidemic. It is important to describe the burden of disease and social circumstances of uninfected children due to their increasing numbers and as they are often used as a comparison group when addressing the effect of vertically-acquired HIV infection on child morbidity and development (ECS, 2003c;Kattan et al , 2001).…”