Prognostic factors and survival in children with perinatal HIV-1 infection

The signs that may arise after perinatal infection with human immunodeficiency virus type 1 (HIV-1) have been classified by the Centers for Disease Control, but the clinical usefulness of the classification system and the prognostic importance of each disease pattern have not been established. We sought to address these issues by analysing data from the Italian Register for HIV infection in children. We studied 1887 children born to HIV-1-seropositive mothers. 1045 were identified at birth and the others were registered later (median age 4.8 [range 0.4-72] months). HIV-1-associated signs developed in 433 (81.8%) of 529 seropositive infected children at a median age of 5 (0.03-84) months. These signs appeared significantly earlier in the 102 children who died of HIV-1-related illness than in those who are still alive (median 3 [0.03-55] vs 6 [0.03-84] months; p less than 0.001). The cumulative proportion surviving at age 9 years was 49.5% (95% confidence interval 27-65%) and the median survival time was 96.2 months. Separate analysis of the 112 seropositive infected children followed from birth and older than 15 months gave similar results. Hepatomegaly, splenomegaly, lymphadenopathy, parotitis, skin diseases, and recurrent respiratory tract infections formed the mildest disease pattern. Lymphoid interstitial pneumonitis and thrombocytopenia were signs of intermediate disease. By contrast, in multivariate analysis specific secondary infectious diseases, severe bacterial infections, progressive neurological disease, anaemia, and fever were significant and independent negative predictors of survival. Growth failure, persistent oral candidosis, hepatitis, and cardiopathy were associated in univariate analysis with significantly shorter survival. Our findings suggest that the outlook for children with perinatal HIV-1 infection is better than previously thought and that a new clinical staging system of single disease patterns is needed

Epidemiology, clinical features and prognostic factors of pediatric HIV infection

486 children born to HIV-positive mothers, 57 children infected by blood products, and 1 child for whom the personal history was not available were studied. Perinatal infection had a more varied clinical picture and a worse outcome compared with infection acquired later in childhood. Severe secondary infections, neurological disorders, and hepatitis (but not lymphoid interstitial pneumonia) were linked to a high mortality rate in perinatally infected children, in whom an early onset of symptoms was also a bad prognostic factor. Perinatal HIV infection occurred in 32·6% of children born to seropositive mothers, with a higher transmission rate in children born by vaginal delivery and then breast-fed. Preterm delivery and low birthweight seemed to be related to drug abuse during pregnancy, not to intrauterine HIV infection. Girls had a higher rate of perinatal infection and, of those infected, had an increased mortality

ITALIAN REGISTER FOR HIV-1 INFECTION IN CHILDREN - REPORT UP TO 30-3-1990 (1422 CHILDREN ENROLLED)

The Italian Register for HIV-1 infection in children was instituted in 1985 by the Italian Association of Pediatrics. As of March 1990, 1422 children (1321 born to seropositive mothers, 99 infected by blood products and 2 whose personal history was not available) were enrolled in our multicentre study. The number of perinatally exposed children was higher in industrialized areas and has been increasing over the years. Intravenous drug use (66.4%), sexual contacts with infected partner (14.5%) or both (15.6%) were the main mother's risk factors, with increasing proportion of those infected by sexual contacts (up to 21% in 1989). The mother-to-offspring transmission rate was 19.9%, when assessed in first born children prospectively followed-up from birth who remained seropositive after 18 months of age. Efficiency of infection was higher in children born to symptomatic mothers, whereas it was unaffected by mode of delivery, gestational age or birthweight. The role of breast-feeding remains doubtful. The risk of infection was not increased at second pregnancy (33 siblings studied) and infection status was disconcordant only in 1/10 twin pairs. Perinatally exposed population consisted of 396 infants whose infection status was still indeterminate (P-0), 388 infected children (93 P-1), including 31 antibody-negative, viral marker-positive subjects, and 295 P-2) and 537 uninfected children. 82.6% of infected seropositive children developed HIV-related clinical manifestations at a median age of 4 months. 69 (23.4%) P-2 patients have died at a median age of 12 months. Decreased CD4 + lymphocyte counts and increased serum immunoglobulin levels in the first months of life were indexes of disease progression rather than of infection status. Specific secondary infections, neurologic disorders, growth failure, fever, anemia and hepatitis were significantly and independently correlated to a poor prognosis. 688 doses of diphteria-tetanus vaccine, 476 of inactivated polyomielitis and 327 of attenuated live polyomielitis vaccine were administered in infected infants with no recorded side effects. Among bloodborne HIV-1 infections (48 haemophilics, 41 beta-thalassemics and 10 occasionally transfused children), only anecdotal cases have been recorded after 1985, when specific preventive measures were adopted. Clinical evolution was worse in perinatally infected children when compared to that of those who acquired infection through administration of blood products. HIV-1 infection in childhood has become a main problem in Italy. Diffusion by blood products has been widely restrained, but the increasing number of perinatally infected children indicates that further specific efforts and strategies in the field of public health are needed