Author
Affilliation
Abstract
Objectives: To evaluate whether maternal HIV disease severity during pregnancy is associated with an increased likelihood of lower respiratory tract infections (LRTIs) in HIV-exposed, uninfected infants. Methods: HIV-exposed, uninfected, singleton, term infants enrolled in the NISDI Perinatal Study, with birth weight ≥ 2500 grams were followed from birth until six months of age. LRTI diagnoses, hospitalizations, and associated factors were assessed. Results: Of 547 infants, 103 (18.8%) experienced 116 episodes of LRTIs (incidence=0.84 LRTIs/100 child-weeks). Most (81%) episodes were bronchiolitis. Forty-nine (9.0%) infants were hospitalized at least once with an LRTI. There were 53 hospitalizations (45.7%) for 116 LRTI episodes. None of these infants were breastfed. The odds of LRTI in infants whose mothers had CD4%<14 were 4.4 times than that of those whose mothers had CD4%≥29 (p=0.003). The odds of LRTI were 16.0 times that of infants with a CD4+ count [cells/mm3] < 750 at birth compared to those with CD4+≥750 (p=0.002). Maternal CD4+ decline and Infant hemoglobin at the 6-12 week visit were associated with infant LRTIs after 6-12 weeks and before six months of age. Conclusions: Acute bronchiolitis is common and frequently severe among HIV-exposed, uninfected infants aged six months or less. Lower maternal and infant CD4+ values were associated with a higher risk of infant LRTIs. Further understanding of the immunological mechanisms of severe LRTIs is needed.
Publisher
Elsevier
Citation
MUSSI-PINHATA, Marisa M. et al. Lower respiratory tract infections among human immunodeficiency virus-exposed, uninfected infants. International Journal of Infectious Diseases, v. 14, suppl. 3, p. 1-16, Sept. 2010.
DOI
10.1016/j.ijid.2010.01.006
ISSN
1201-9712
Notes
Beatriz Grinsztejn; Valdilea Veloso. Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Documento produzido em parceria ou por autor vinculado à Fiocruz, mas não consta a informação no documento.
NISDI Perinatal Study Group Principal investigators, co-principal investigators, study coordinators, coordinating center representatives, and NICHD staffinclude: Argentina: Buenos Aires: Marcelo H. Losso, Adriana S.Durán, Silvina Ivalo (Hospital General de Agudos Jose ́Marı ́a Ramos Mejía); Brazil: Belo Horizonte: Jorge Pinto, Victor Melo, Fabiana Kakehasi (Universidade Federal de Minas Gerais); Caxias do Sul: Ricardo da Silva de Souza, Nicole Golin, Sílvia Mariani Costamilan (Universidade de Caxias do Sul/Serviço Municipal de Infectologia);Nova Iguacu: Jose Pilotto, Beatriz Grinsztejn, Valdilea Veloso(Hospital Geral Nova de Iguacu - HIV Family Care Clinic); Porto Alegre: Ricardo da Silva de Souza, Breno Riegel Santos, Rita de Cassia Alves Lira (Universidade de Caxias do Sul/Hospital Conceição); Ricardo da Silva de Souza, Mario Peixoto, Elizabete Teles (Universidade de Caxias do Sul/Hospital Fêmina); Regis Kreitchmann, Debora Fernandes Coelho (Irmandade da Santa Casa de Misericordia de Porto Alegre); Ribeirão Preto: Marisa M. Mussi-Pinhata, Geraldo Duarte, Carolina Sales V. Macedo, Adriana A. Tiraboschi Bárbaro, Conrado Milani Coutinho (Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo); Rio de Janeiro: Ricardo Hugo S. Oliveira, Elizabeth S. Machado, Maria C. Chermont Sapia (Instituto de Puericultura e Pediatria Martagão Gesteira); Esau Custodio Joao, Leon Claude Sidi,Guilherme Amaral Calvet, Claudete Araújo Cardoso (Hospital dos Servidores do Estado); Sa ̃o Paulo: Regina Celia de Menezes Succi, Prescilla Chow Lindsey (Federal University of São Paulo); Peru: Lima: Jorge Alarcón (Instituto de Medicina Tropical ‘‘Daniel Alcides Carrión’’ – Sección de Epidemiologıa, UNMSM), Carlos Velásquez Vásquez (Instituto Nacional Materno Perinatal), César Gutiérrez Villafuerte (Instituto de Medicina Tropical ‘‘Daniel Alcides Carrión’’– Sección de Epidemiología, UNMSM); Data Management and Statistical Center: Yolanda Bertucci, Laura Freimanis Hance, René Gonin, D. Robert Harris, Roslyn Hennessey, James Korelitz, Margot Krauss, Sharon Sothern, Sonia K. Stoszek (Westat, Rockville, MD,USA); NICHD: Rohan Hazra, Lynne Mofenson, Jennifer S. Read, Heather Watts, Carol Worrell (Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA.
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