title: Severe, rapidly progressive human immunodeficiency virus type 1 disease in newborns with coinfections.
abstract: OBJECTIVE
  To describe a severe form of rapidly progressive HIV-1 infection manifesting in the neonatal period.
  
  
  METHODS
  Prospective cohort study, King Edward VIII Hospital, Durban, South Africa. HIV-1-exposed neonates with hepatosplenomegaly, lymphadenopathy or persistent pneumonia within the first 28 days of life were investigated for perinatal infections. Confirmation of neonatal HIV-1 infection, HIV-1 subtype and clinical outcomes were studied.
  
  
  RESULTS
  Twenty-three (72%) of 32 symptomatic HIV-1-exposed neonates recruited at a mean of 15.2 days were HIV-1-infected. HIV-1 infection was detected in 5 patients who were tested within 48 h of birth, confirming congenital infection. Congenital infection was not excluded in any case. Median neonatal viral load at recruitment was 471,932 copies/ml and median CD4 was 777 cells/mm3. The predominant clinical presentation was growth retardation and prematurity. Perinatal infections detected included: tuberculosis (8), syphilis (6) and cytomegalovirus (10). All of the neonates with perinatal tuberculosis were HIV-1-coinfected. Maternal and neonatal viral load and CD4 at recruitment were not statistically different between the groups with tuberculosis vs. other coinfections. Gag gene sequence analysis confirmed closely aligned HIV-1 subtype C in mothers and neonates. Nineteen (83%) died by 9 months, with a mean age at death of 3.5 months.
  
  
  CONCLUSIONS
  A distinct group of HIV-1-infected babies may clinically manifest in the neonatal period with perinatal coinfections, subsequent rapidly progressive HIV-1 and early death.
authors.affiliation: Department of Paediatrics and Child Health, University of Natal, Medical School, South Africa.
authors.forename: T
authors.initials: T
authors.lastname: Pillay
authors.forename: M
authors.initials: M
authors.lastname: Adhikari
authors.forename: J
authors.initials: J
authors.lastname: Mokili
authors.forename: D
authors.initials: D
authors.lastname: Moodley
authors.forename: C
authors.initials: C
authors.lastname: Connolly
authors.forename: T
authors.initials: T
authors.lastname: Doorasamy
authors.forename: H M
authors.initials: HM
authors.lastname: Coovadia
mesh_terms: D017088:AIDS-Related Opportunistic Infections; D003586:Cytomegalovirus Infections / Q000150:complications; D003906:Developing Countries; D015658:HIV Infections / Q000151:congenital* / Q000175:diagnosis / Q000503:physiopathology* / Q000635:transmission; D015497:HIV-1 / Q000235:genetics; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D011446:Prospective Studies; D013587:Syphilis / Q000150:complications; D014376:Tuberculosis / Q000150:complications