Infectious disease morbidity among young HIV-1-exposed but uninfected infants in Latin American and Caribbean countries: the National Institute of Child Health and Human Development International Site Development Initiative Perinatal Study
Mussi-Pinhata, M.M.; Freimanis, L.; Yamamoto, A.Y.; Korelitz, J.; Pinto, J.A.; Cruz, M.L.S.; Losso, M.H.; Read, J.S.
Pediatrics 119(3): E694-E704
2007
ISSN/ISBN: 1098-4275 PMID: 17296782 DOI: 10.1542/peds.2006-1856Document Number: 207252
OBJECTIVE. The goal was to describe the frequency, characteristics, and correlates of infectious disease morbidity during the first 6 months of life among HIV-1 exposed but uninfected infants.METHODS. The study population consisted of infants enrolled in the National Institute of Child Health and Human Development International Site Development Initiative Perinatal Study who were HIV-1 uninfected and had follow- up data through the 6- month study visit. Definitive and presumed infections were recorded at study visits ( birth, 6 - 12 weeks, and 6 months).RESULTS. Of 462 HIV-1-uninfected infants with 11 644 child- weeks of observation, 283 experienced >= 1 infection. These 283 infants experienced 522 infections ( 1.8 infections per infant). The overall incidence rate of infections was 4.5 cases per 100 child- weeks of observation. Overall, the most common infections were skin or mucous membrane infections ( 1.9 cases per 100 child- weeks) and respiratory tract infections ( 1.7 cases per 100 child- weeks). Thirty-six percent of infants had > 1 respiratory tract infection ( 1.8 cases per 100 child- weeks). Incidence rates of upper and lower respiratory tract infections were similar ( 0.89 cases per 100 child- weeks and 0.9 cases per 100 child- weeks, respectively). Cutaneous and/ or oral candidiasis occurred in 48 neonates ( 10.3%) and 92 older infants ( 19.3%). Early neonatal sepsis was diagnosed in 12 infants ( 26.0 cases per 1000 infants). Overall, 81 of 462 ( 17.5%) infants were hospitalized with an infection. Infants with lower respiratory tract infections were hospitalized frequently ( 40.7%). The occurrence of >= 1 neonatal infection was associated with more- advanced maternal HIV-1 disease, tobacco use during pregnancy, infant anemia, and crowding. Lower maternal CD4(+) cell counts, receipt of intrapartum antibiotic treatment, and country of residence were associated with postneonatal infections.CONCLUSIONS. Close monitoring of HIV-1-exposed infants, especially those who are anemic at birth or whose mothers have more- advanced HIV-1 disease or who smoked during pregnancy, remains important.