Pneumocystis carinii pneumonia in vertically acquired HIV infection in the British Isles
Related Experiment Videos
D M Gibb1, C F Davison, F J Holland
1Department of Epidemiology and Biostatistics, Institute of Child Health, London.
Insights
Pediatric Pneumocystis pneumonia in vertically HIV-infected children is common and has a poor prognosis, often presenting before HIV risk is known. Early diagnosis and treatment are crucial for improved survival rates.
Area of Science:
- Pediatric Infectious Diseases
- HIV/AIDS Research
- Immunology
Background:
- Pneumocystis carinii pneumonia (PCP) is a significant opportunistic infection in vertically HIV-infected children.
- Early diagnosis and treatment are critical for improving outcomes in pediatric HIV.
- Limited data exists on the clinical course and outcomes of PCP in this vulnerable population.
Purpose of the Study:
- To review the clinical course, laboratory findings, and outcomes of children with vertically acquired HIV infection and PCP.
- To assess the frequency of PCP as an AIDS-defining illness in infants.
- To evaluate the survival rates and subsequent disease progression in children with PCP.
Main Methods:
- A retrospective review using questionnaires sent to pediatricians in the British Isles.
- Data linkage with the British Paediatric Surveillance Unit (BPSU) for HIV and PCP reports.
- Analysis of clinical course, laboratory findings, and survival data.
Main Results:
- PCP was the most frequent AIDS-defining illness at diagnosis in 40% of children born in the British Isles.
- Median age at PCP diagnosis was 4.1 months; 48% had concurrent AIDS-defining illnesses.
- Three-month survival was only 38%, with survivors often developing further AIDS-defining conditions.
Conclusions:
- Children with vertically acquired HIV infection develop PCP at an early age with a poor prognosis.
- Increased awareness is needed for early diagnosis and treatment of PCP.
- Pregnancy screening for HIV may be incentivized by PCP prevention, but further research on prophylaxis is required.
Abstract:
In order to review the clinical course, laboratory findings, and outcome of children with vertically acquired HIV infection and Pneumocystis carinii pneumonia, questionnaires were sent to paediatricians in the British Isles who had reported P carinii pneumonia and HIV infection through the British Paediatric Surveillance Unit (BPSU). Paediatric reports from the BPSU are linked to reports of pregnancies in HIV positive women and laboratory reports. P carinii pneumonia was the most frequently reported AIDS indicator disease at AIDS diagnosis, occurring in 22/56 (40%) children born in the British Isles; in a further two children P carinii pneumonia occurred after another AIDS indicator disease. The median age at P carinii pneumonia diagnosis was 4.1 (1.4-27.3) months and in 48% it occurred with other AIDS indicator diseases. Despite intensive treatment the three month survival was only 38%. The nine children surviving P carinii pneumonia subsequently developed further AIDS indicator diseases, in particular HIV encephalopathy and four have since died. P carinii pneumonia was present at AIDS diagnosis in 65% of children developing AIDS in the first year of life and caused 82% of infant deaths. Most children were not known to be at risk of HIV until they presented with P carinii pneumonia. Children with HIV infection develop P carinii pneumonia at an early age and have a poor outcome. Increased awareness of the condition is required to initiate early treatment. Prevention may be a compelling incentive for screening in pregnancy, but further study is required to quantify the risks and benefits of initiating early P carinii pneumonia prophylaxis as well as the impact this might have on life expectancy.