Lower respiratory tract infections among human immunodeficiency virus-exposed, uninfected infants
Mussi-Pinhata, M.M.; Motta, F.; Freimanis-Hance, L.; de Souza, R.; Szyld, E.; Succi, R.C.M.; Christie, C.D.C.; Rolon, M.J.; Ceriotto, M.; Read, J.S.; Losso, M.H.; Durán, A.S.; Ivalo, S.; Pinto, J.; Melo, V.; Kakehasi, F.; da Silva de Souza, R.; Golin, N.; Mariani, S.íl.; Pilotto, J.; Grinsztejn, B.; Veloso, V.; da Silva de Souza, R.; Riegel Santos, B.; de Cassia Alves Lira, R.; da Silva de Souza, R.; Peixoto, M.; Teles, E.; Kreitchmann, R.; Fernandes Coelho, D.; Mussi-Pinhata, M.M.; Duarte, G.
International Journal of Infectious Diseases Ijid Official Publication of the International Society for Infectious Diseases 14(Suppl 3): E176-E182
2010
ISSN/ISBN: 1878-3511 PMID: 20452798 DOI: 10.1016/j.ijid.2010.01.006Document Number: 578205
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. HIV-exposed, uninfected, singleton, term infants enrolled in the NISDI Perinatal Study, with birth weight >2500g were followed from birth until 6 months of age. LRTI diagnoses, hospitalizations, and associated factors were assessed. Of 547 infants, 103 (18.8%) experienced 116 episodes of LRTI (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 at enrollment were 4.4 times those of infants whose mothers had CD4% ≥29 (p=0.003). The odds of LRTI in infants with a CD4+ count (cells/mm(3)) <750 at hospital discharge were 16.0 times those of infants 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 6 months of age. Acute bronchiolitis is common and frequently severe among HIV-exposed, uninfected infants aged 6 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.