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Neonatal characteristics in rapidly progressive perinatally acquired HIV-1 disease. The French Pediatric HIV
M J Mayaux1, M Burgard, J P Teglas
1Institut National de la Santé et de la Recherche Médicale, Hôpital Bicêtre, Le Kremlin-Bicêtre, France.
Insights
Early identification of severe pediatric HIV-1 disease is possible. Clinical signs like enlarged liver/spleen and low CD4+ cell counts at birth, along with virological markers, predict rapid disease progression in infants born to HIV-infected mothers.
Area of Science:
- Pediatric Infectious Diseases
- Virology
- Immunology
Background:
- Human Immunodeficiency Virus type 1 (HIV-1) infection in children poses significant health challenges.
- Identifying early indicators of rapidly progressive disease is crucial for timely intervention.
- Children born to HIV-seropositive mothers are at risk of vertical transmission and subsequent disease.
Purpose of the Study:
- To pinpoint clinical and laboratory parameters present at birth that correlate with the rapidly progressive form of HIV-1 disease in infants.
- To establish predictive markers for severe pediatric HIV-1 outcomes.
Main Methods:
- A multicenter, prospective study involving infants born to HIV-1-seropositive mothers in France.
- Analysis of clinical, immunological (CD4+ cell counts), and virological (HIV-1 culture, PCR, antigenemia) findings at birth.
- Follow-up of 267 infected infants for Category C events within the first year of life.
Main Results:
- Enlarged liver/spleen and/or adenopathies at birth were associated with a 2.5-fold increased risk of Category C manifestations by 12 months.
- A low proportion (<30%) of CD4+ cells at birth increased the risk by 3.0 times.
- Positive HIV-1 culture, PCR, or antigenemia in the first week of life significantly elevated the risk of early, severe HIV-1 disease (RR 2.8-3.5).
Conclusions:
- Clinical and virological parameters at birth serve as valuable prognostic markers for monitoring HIV-infected children.
- These markers can aid in identifying infants at high risk for rapid disease progression.
- Early identification facilitates prompt therapeutic interventions for better patient outcomes.
Objective:
To identify clinical and laboratory parameters at birth that are associated with the rapidly progressive form of human immunodeficiency virus type 1 (HIV-1) disease in children born to infected mothers.
Design:
Multicenter, prospective study of infants born to HIV-seropositive mothers.
Setting:
A total of 62 obstetric and pediatric centers in France.
Participants:
Of 1386 children born to HIV-1-seropositive mothers at least 18 months before the cutoff date, 267 were infected. Infection was defined as serological positivity at 18 months or death from HIV disease before the age.
Main Outcome Measure:
Category C events (including opportunistic infections, recurrent severe bacterial infections, cancers, specific encephalopathy, and wasting syndrome) in the new pediatric Centers for Disease Control and Prevention classification during the first year of life, according to clinical, immunological, and virological findings at birth.
Results:
The risk of category C manifestations at 12 months was significantly higher when an infected newborn had liver and/or spleen enlargement and/or adenopathies (38.1% vs 15.1%; relative risk [RR], 2.5; 95% confidence interval [CI], 1.4 to 6.0; P<.02) or a low proportion (<30%) of CD4+ cells at birth (45.5% vs 15.0%; RR, 3.0; 95% CI, 1.4 to 6.4; P<.005). Similarly, HIV-1 culture and/or polymerase chain reaction positivity during the first week of life was associated with a higher risk of the early, severe form of HIV infection (26.4% vs 9.3%; RR, 2.8; 95% CI, 1.3 to 6.1; P<.006). In case of positive antigenemia at birth, the risk was 50.0% vs 14.4% (RR, 3.5; 95% CI, 1.9 to 6.2; P<.001). These parameters, determined at birth, were strongly interrelated and could reflect active disease onset in utero in some cases of early, severe HIV-1 disease in childhood.
Conclusions:
These prognostic markers, particularly virological parameters, are of value in monitoring children infected by HIV and might serve as a basis for early therapeutic intervention.