Invasive pneumococcal disease among infected and uninfected children of mothers with human immunodeficiency virus infection.
OBJECTIVE
To describe the incidence and clinical presentation of invasive pneumococcal disease in a cohort of children infected with human immunodeficiency virus (HIV) who were prospectively followed from birth, in comparison with uninfected children born to HIV-infected mothers and control children.


METHODS
Prospective follow-up of a cohort recruited at birth and born to mothers with known HIV status. The person-years analysis method used the occurrence of invasive pneumococcal disease as the end point.


METHODS
Hospital-based clinic specializing in care of HIV-at-risk and HIV-infected children in Baltimore, Md.


METHODS
Forty-one vertically HIV-infected children, 128 uninfected children born to HIV-infected mothers, and 71 control children born to mothers with negative findings for HIV but with HIV risk factors.


RESULTS
Among HIV-infected children, 10 episodes of invasive pneumococcal disease occurred during the first 36 months of life compared with 4 episodes among uninfected children and 1 episode among control subjects. The relative risk for HIV-infected children versus the combined uninfected and control groups was 12.6 with a 95% confidence interval (5.4, 28.8) and a p value for difference between groups of < 0.001. The incidence rate per 100 child-years of observation during the first 36 months of life was 11.3 for HIV-infected, 1.1 for uninfected, and 0.5 for control children. Clinical and laboratory variables were not useful in identifying HIV-infected children at risk for pneumococcal disease.


CONCLUSIONS
Practical strategies to prevent pneumococcal disease among HIV-infected children need to be developed.
Farley
J J
JJ
Department of Pediatrics, University of Maryland School of Medicine, Baltimore 21201.
King
J C
JC
Nair
P
P
Hines
S E
SE
Tressler
R L
RL
Vink
P E
PE
D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications* / Q000151:congenital*; D015497:HIV-1; D006801:Humans; D015994:Incidence; D007223:Infant; D011008:Pneumococcal Infections / Q000453:epidemiology / Q000209:etiology*; D011446:Prospective Studies; D018805:Sepsis / Q000209:etiology*