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[Features in human immunodeficiency virus type 1 in the neonatal period]
E Moliner Calderón1, C Fortuny Guasch, T Sorni Hubrecht
1Sección de Neonatología, Hospital de Sant Joan de Déu, Facultad de Medicina. Universidad de Barcelona.
Insights
Infants infected with human immunodeficiency virus type 1 (HIV-1) during gestation experience accelerated disease and higher mortality. Early detection and understanding of intra-uterine transmission are critical for pediatric HIV-1 management.
Area of Science:
- Pediatric Infectious Diseases
- Virology
- Immunology
Context:
- Human immunodeficiency virus type 1 (HIV-1) infection in newborns presents diverse clinical patterns.
- The exact timing of vertical HIV-1 transmission remains challenging to determine.
- Intra-uterine transmission may lead to more severe and rapid disease progression compared to intrapartum or delivery-related infections.
Purpose:
- To investigate the clinical manifestations and laboratory findings in newborns diagnosed with HIV-1 infection.
- To correlate early clinical and laboratory findings with disease progression and outcomes in vertically infected infants.
Summary:
- Seven newborns with HIV-1 infection were studied, with all exhibiting clinical or laboratory features at birth.
- Prematurity was common (71.4%), with frequent findings including hepatomegaly, failure to thrive, splenomegaly, lymphadenopathy, thrombocytopenia, and cellular immunosuppression.
- HIV-1 infection was confirmed on day one of life via antigen detection, PCR, or viral culture, with a 70% mortality rate within the first year.
Impact:
- Findings suggest intra-uterine HIV-1 infection leads to accelerated disease, early AIDS manifestation, and increased mortality in newborns.
- Maternal factors such as infection characteristics, immune status, and antibody levels, alongside fetal factors like prematurity, may influence intra-uterine transmission and disease severity.
Unlabelled:
Different patterns of disease expression have been found in pediatric HIV1 infection. The precise timing of vertical transmission of HIV1 cannot be pinpointed. Some studies suggests that a substantial proportion of infants are infected during gestation are likely to have more extensive infection and thus more accelerated disease that infants who become infected during labor or delivery.
Patients:
We examined the clinical manifestations and laboratory findings in seven newborns with HIV1 infection.
Results:
In all patients, have been bound clinical or laboratory features at birth. Five newborn was prematurely (71.4%). The most common clinical findings in this group was: hepatomegaly (6/7), failure to drive (6/7), esplenomegaly (5/7) and limphadenopaties (5/7). The laboratory findings was: trombopeny and cellular immunosuppression (5/7). The HIV1 infection was determined by detection of p24 antigen, chain reaction polymerase or viral cocultive in blood in the first day of live. The mortality in this group was the 70% in the first year of life.
Comments:
This results suggest that the timing of HIV1 infection was intrauter. This group has an accelerated disease course, developing manifestations of AIDS in first month of life and dying earlier. Although, a variety of maternal and fetal factors may contributed to the intrauter infection, for example the characteristics of the mother's infection, immune status, level of HIV1-neutralizing antibody, p24 antigaenemia prematurity and others.