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Invasive pneumococcal infections in human immunodeficiency virus-infected children
1Division of Infectious Diseases, Children's Hospital, Boston, Massachusetts, USA.
Insights
Invasive pneumococcal infection (IPI) is common in children with human immunodeficiency virus (HIV). IPI risk increases with prior AIDS diagnosis and higher immunoglobulin levels in HIV-infected children.
Area of Science:
- Pediatric Infectious Diseases
- Immunology
- Epidemiology
Background:
- Invasive pneumococcal infection (IPI) is a leading cause of serious bacterial infection in children with human immunodeficiency virus (HIV).
- Understanding IPI incidence and risk factors in this vulnerable population is crucial for effective prevention and management.
Purpose of the Study:
- To determine the incidence of IPI in HIV-infected children.
- To identify risk factors associated with IPI in HIV-infected children.
- To compare IPI manifestations between HIV-infected and HIV-negative children.
Main Methods:
- Population-based pediatric HIV surveillance data were analyzed.
- A case-control study design was employed to assess risk factors.
- IPI cases in HIV-infected children were compared to HIV-negative controls.
Main Results:
- The cumulative incidence of IPI was 6.1 cases/100 patient-years through age 7.
- Prior AIDS diagnosis (OR, 4.2) and higher IgG/IgM levels were associated with increased IPI risk.
- HIV-infected children had lower rates of leukocytosis and higher rates of penicillin-resistant IPI isolates compared to controls.
Conclusions:
- HIV-infected children face a significant burden of IPI, with specific risk factors identified.
- Clinical manifestations and antimicrobial resistance patterns of IPI differ between HIV-infected and HIV-negative children.
- These findings underscore the need for targeted interventions and surveillance for IPI in pediatric HIV.
Abstract:
Invasive pneumococcal infection (IPI) is the most common serious bacterial infection in human immunodeficiency virus (HIV)-infected children. Data from a population-based pediatric HIV surveillance project were used to determine the incidence of IPI in HIV-infected children and to conduct a case-control study assessing potential risk factors for IPI in HIV-infected children. There were 50 episodes of IPI and a cumulative incidence of 6.1 cases/100 patient-years through age 7 years. Children with IPI were more likely to have a prior AIDS diagnosis (odds ratio, 4.2; 95% confidence interval, 1.2-15.1) and higher levels of IgG and IgM (P=.01) than were controls. In a separate case-control study, the manifestations of IPI in HIV-infected children were compared with those in HIV-negative controls. Focal complication rates in the 2 groups did not differ; however, HIV-infected children were less likely than controls to have leukocytosis (P<.001) and more likely to have isolates with penicillin resistance (P=.03).