Neonatal characteristics in rapidly progressive perinatally acquired HIV-1 disease. The French Pediatric HIV Infection Study Group.
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.


METHODS
Multicenter, prospective study of infants born to HIV-seropositive mothers.


METHODS
A total of 62 obstetric and pediatric centers in France.


METHODS
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.


METHODS
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.
Mayaux
M J
MJ
Institut National de la Santé et de la Recherche Médicale, Hôpital Bicêtre, Le Kremlin-Bicêtre, France.
Burgard
M
M
Teglas
J P
JP
Cottalorda
J
J
Krivine
A
A
Simon
F
F
Puel
J
J
Tamalet
C
C
Dormont
D
D
Masquelier
B
B
Doussin
A
A
Rouzioux
C
C
Blanche
S
S
D015492:AIDS Serodiagnosis / Q000379:methods; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000151:congenital* / Q000175:diagnosis / Q000503:physiopathology / Q000635:transmission; D006679:HIV Seropositivity / Q000151:congenital / Q000175:diagnosis / Q000503:physiopathology / Q000635:transmission; D015497:HIV-1 / Q000302:isolation & purification; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D016133:Polymerase Chain Reaction; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000821:virology*; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis