Survival in children with perinatally acquired human immunodeficiency virus type 1 infection

Gb, Scott; Hutto, Cecelia; Makuch, RW; Mastrucci, MT; O’Connor, Tim; Mitchell, CD; Trapido, EJ; Parks, WP

doi:10.1016/0020-7292(90)90032-g

Cited by 35 publications

(63 citation statements)

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“…The age distribution of long-term survivors was skewed toward the younger age group (8 years) among perinatally HIV-infected children which is in accordance with reports on the natural history of HIV infection 1,5,6 and also the timing of the pediatric epidemic (historically HIV acquired via blood transfusion occurred earlier in the AIDS epidemic whereas the perinatally acquired HIV epidemic peaked years later). The cohort surveyed only included living children and not children who might have died before or after 8 years because this survey was conducted in anticipation of future long-term survivor studies.…”

Section: Discussionsupporting

confidence: 88%

“…1,2 The group of children who develop early and severe disease, frequently with the development of acquired immunodeficiency syndrome (AIDS)-defining illnesses and with a higher likelihood of death in the first years of life, have been identified as rapid progressors. 2 There is, however, a group of children who have survived for many years after the diagnosis of HIV infection.…”

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confidence: 99%

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A Descriptive Survey of Pediatric Human Immunodeficiency Virus–infected Long-term Survivors

Nielsen

McSherry

Petru³

et al. 1997

Pediatrics

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ABSTRACT. Objective. To identify the population of human immunodeficiency virus-infected pediatric longterm survivors (LTS) followed in major medical institutions in California, Florida and New Jersey.Methods. A cross-sectional survey was performed with data collection forms sent to all investigators. Demographic, clinical, and laboratory data were obtained on all living patients 8 years infected in the perinatal period with human immunodeficiency virus.Results. A total of 143 perinatally infected and 54 children infected by neonatal transfusion were identified. Fifty-four children (27%) had absolute CD4 counts 500 cells/mm 3 (group 1: mean age 9.8 years), 54 children (27%) had CD4 counts between 200 and 500 cells/mm 3 (group 2: mean age 10.1 years), and 89 children (45%) had CD4 counts <200 cells/mm 3 (group 3: mean age 10.4 years). Ninety-five (48%) patients had developed AIDS defining conditions; 14 (26%) in group 1, 26 (48%) in group 2, and 55 (62%) in group 3. Ninety-two percent of patients had received antiretrovirals. Perinatally human immunodeficiency virus-infected children tended to be younger (mean age 9.8 years) than children infected via a blood transfusion (mean age 11 years). Generalized lymphadenopathy was the most prevalent clinical finding. Lymphoid interstitial pneumonia and recurrent bacterial infections were the most prevalent acquired immune deficiency syndrome-defining conditions. Twenty percent of LTS had CD4 counts 500 cells/mm 3 and no immune deficiency syndrome-defining conditions.Conclusions. Pediatric LTS were in variable stages of disease progression. The proportion of children within each CD4 strata did not differ by mode of acquisition of infection. Increased CD4 counts were inversely proportional to age. Only 20% of pediatric LTS had minimal to no disease progression. Pediatrics 1997;99(4). URL: http: //www.pediatrics.org/cgi/content/full/99/4/e4; HIV, pediatric long-term survivors, slow disease progression.

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Section: Discussionsupporting

confidence: 88%

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confidence: 99%

A Descriptive Survey of Pediatric Human Immunodeficiency Virus–infected Long-term Survivors

Nielsen

McSherry

Petru³

et al. 1997

Pediatrics

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“…The infants might thus be at a particularly high risk of transmission both early in maternal HIV infection and late in maternal AIDS. Interestingly, a small number of children infected as infants have remained asymptomatic for as many as 8 years [38], and children who are vertically HIV-2-infected seem to have a better prognosis than HIV-1-infected children [39].…”

Section: Discussionmentioning

confidence: 99%

Antibody-dependent cellular cytotoxicity and neutralizing activity in sera of HIV-1-infected mothers and their children

Broliden

Sievers

Tovo

et al. 1993

Clinical and Experimental Immunology

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SUMMARYThe prognostic and protective role of antibodies mediating cellular cytotoxicity (ADCC) and neutralization was evaluated in sera of HIV-1-infected mothers and their consecutively followed children. The presence and titres of ADCC mediating and/or neutralizing antibodies in maternal sera did not predict HIV-1 infection in their respective children. No significant diflFerence in the sera from the children was seen when comparing the presence of neutralizing antibodies between the uninfected and infected children. Stratification of the infected group according to clinical status revealed differences. Only one of 24 AIDS patients had a high neutralizing titre against IIIB. Four patients had a very low titre and the remaining had no detectable neutralizing antibodies at all. In contrast, 10/17 infected non-AIDS children had neutralizing antibodies. Similarly, no significant difference was seen when comparing the presence of ADCC-mediating antibodies between the uninfected and the infected group of children. However, a significantly higher frequency of ADCC was seen in the seropositive non-AIDS children compared with the AIDS children. This study clearly shows that the presence of antibodies mediating ADCC and neutralization in infected children, 0-2 years old, is associated with a better clinical status and delayed disease progression.

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“…ARTs initiation before category C or severe immunosuppression was also associated with LTNP. Key-Words: HIV, antiretroviral therapy, long term non-progressors, children, Brazil.It is estimated that 20-40% of HIV-1-infected children present with rapid disease progression and develop AIDS within the first years of life [1][2][3][4]. On the other hand, 60-80% of infected children manifest less severe symptoms and many survive through adolescence [3][4][5][6].…”

mentioning

confidence: 99%

“…Although there is some evidence that infants benefit from treatment started in their first year of life, with early HIV replication control and preservation of the immune system [3,4,11], aspects associated with HAART adverse events, adherence and emergence to drug resistant virus must also be considered [5]. Another important issue is the possibility that almost 50% [1][2][3][4] of these infants would be long-term nonprogressors (LTNP), and would not benefit from HAART until five years of age or older. It is important to identify early life events that might be associated with long-term nonprogressors, so HAART could be individualized even among infants.…”

mentioning

confidence: 99%

Neonatal factors associated with HIV long term non-progressors in a cohort of vertically infected children in Rio de Janeiro, Brazil ("Peixe" Project)

Hofer¹,

Oliveira²,

Machado³

et al. 2009

Braz J Infect Dis

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There are only scarce data on HIV progression in vertically infected children in developing countries. The aim of this study is to describe factors from neonatal period associated with long term non-progression (LTNP), in a Brazilian cohort. A cohort study, with data systematically collected from the "Peixe" Cohort (cohort study of children conducted at the main HIV Pediatric Center in Rio de Janeiro, from 1996 to 2005). The study included children who were vertically infected and started follow up at 5 years of age or younger. LTNP, defined as not reaching category C or severe immunosuppression before 5 years of age. Neonatal and demographic factors were studied. Variables with p-value<0.15 were included in a logistic regression model. 213 patients were included, of whom 42% (89/213) were classified as LTNP. Variables independently associated with LTNP were: baseline (at study entry) CD4+ cells (per %) (OR= 1.06, 95%CI=1.01-1.12); age of initiating follow-up, per month (OR= 1.03, 95%CI=1.01-1.06); ZDV use duriing newborn period (OR= 3.31, 95%CI=0.86-12.71); use of antiretroviral (ART) before classification C or severe immunosuppression (OR= 5.89, 95%CI=2.03-17.10). Adjusting for age at the beginning of follow-up, antiretroviral that was unsuccessfully used to prevent maternal-to-child transmission (ZDV use in neonatal period) was associated with better prognosis. ARTs initiation before category C or severe immunosuppression was also associated with LTNP. Key-Words: HIV, antiretroviral therapy, long term non-progressors, children, Brazil.It is estimated that 20-40% of HIV-1-infected children present with rapid disease progression and develop AIDS within the first years of life [1][2][3][4]. On the other hand, 60-80% of infected children manifest less severe symptoms and many survive through adolescence [3][4][5][6]. In developed countries, advanced maternal disease, high maternal viral load, and maternal and infant immune suppression were associated with rapid HIV progression in children [7]. In developing countries, where the majority of perinatal infections occur, there are only scarce data on HIV progression and risk factors. Meanwhile, in some developed countries, all HIV infected children are treated with highly active antiretroviral therapy (HAART) in early infancy. [8]. Brazilian guidelines [9] recommend that HIV infected infants should be treated only if they present any stage B or C symptoms and/or are in immune categories 2 or 3 (CDC) [10]. Although there is some evidence that infants benefit from treatment started in their first year of life, with early HIV replication control and preservation of the immune system [3,4,11], aspects associated with HAART adverse events, adherence and emergence to drug resistant virus must also be considered [5]. Another important issue is the possibility that almost 50% [1-4] of these infants would be long-term nonprogressors (LTNP), and would not benefit from HAART until five years of age or older. It is important to identify early life events that might be associated...

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Survival in children with perinatally acquired human immunodeficiency virus type 1 infection

Cited by 35 publications

References 0 publications

A Descriptive Survey of Pediatric Human Immunodeficiency Virus–infected Long-term Survivors

A Descriptive Survey of Pediatric Human Immunodeficiency Virus–infected Long-term Survivors

Antibody-dependent cellular cytotoxicity and neutralizing activity in sera of HIV-1-infected mothers and their children

Neonatal factors associated with HIV long term non-progressors in a cohort of vertically infected children in Rio de Janeiro, Brazil ("Peixe" Project)

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