Lower respiratory tract infections among human immunodeficiency virus-exposed, uninfected infants.
OBJECTIVE
To evaluate whether maternal HIV disease severity during pregnancy is associated with an increased likelihood of lower respiratory tract infections (LRTIs) in HIV-exposed, uninfected infants.


METHODS
HIV-exposed, uninfected, singleton, term infants enrolled in the NISDI Perinatal Study, with birth weight >2500g were followed from birth until 6 months of age. LRTI diagnoses, hospitalizations, and associated factors were assessed.


RESULTS
Of 547 infants, 103 (18.8%) experienced 116 episodes of LRTI (incidence=0.84 LRTIs/100 child-weeks). Most (81%) episodes were bronchiolitis. Forty-nine (9.0%) infants were hospitalized at least once with an LRTI. There were 53 hospitalizations (45.7%) for 116 LRTI episodes. None of these infants were breastfed. The odds of LRTI in infants whose mothers had CD4% <14 at enrollment were 4.4 times those of infants whose mothers had CD4% ≥29 (p=0.003). The odds of LRTI in infants with a CD4+ count (cells/mm(3)) <750 at hospital discharge were 16.0 times those of infants with CD4+ ≥750 (p=0.002). Maternal CD4+ decline and infant hemoglobin at the 6-12 week visit were associated with infant LRTIs after 6-12 weeks and before 6 months of age.


CONCLUSIONS
Acute bronchiolitis is common and frequently severe among HIV-exposed, uninfected infants aged 6 months or less. Lower maternal and infant CD4+ values were associated with a higher risk of infant LRTIs. Further understanding of the immunological mechanisms of severe LRTIs is needed.
Mussi-Pinhata
Marisa M
MM
Faculty of Medicine of Ribeirão Preto, University of São Paulo, Avenida Bandeirantes 3900, Ribeirão Preto, SP, Brazil. mmmpinha@fmrp.usp.br
Motta
Fabrizio
F
Freimanis-Hance
Laura
L
de Souza
Ricardo
R
Szyld
Edgardo
E
Succi
Regina C M
RC
Christie
Celia D C
CD
Rolon
Maria J
MJ
Ceriotto
Mariana
M
Read
Jennifer S
JS
D000328:Adult; D001118:Argentina; D001938:Brazil; D001988:Bronchiolitis / Q000209:etiology / Q000276:immunology; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000276:immunology* / Q000635:transmission; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D008297:Male; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000276:immunology*; D011297:Prenatal Exposure Delayed Effects / Q000276:immunology*; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000209:etiology* / Q000276:immunology; D012307:Risk Factors
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