title: Opportunistic illnesses in Brazilian children with AIDS: results from two national cohort studies, 1983-2007.
abstract: BACKGROUND
  HAART has significantly reduced AIDS-related morbidity in children. However, limited evidence is available from developing countries regarding patterns of opportunistic illnesses. We describe these events and their associated factors in children with AIDS in Brazil.
  
  
  METHODS
  This study is based on two representative retrospective multi-center cohorts including a total 1,859 children with AIDS, infected via mother-to-child transmission (MTCT), between 1983-2002. Opportunistic illnesses were described and analyzed over time. The association of demographic, clinical and operational data with the occurrence of opportunistic diseases was assessed.
  
  
  RESULTS
  In total, 1,218 (65.5%) had at least one event of an opportunistic disease. Variables significantly associated with occurrence of these events included: region of residence (OR 2.68-11.33, as compared to the Northern region), age < 1 year at diagnosis (OR 2.56, 95% CI 1.81-3.61, p < 0.001), and non-performance of MTCT prevention measures (OR 1.58, 95% CI 1.21-2.07, p < 0.001). Protective factors included year of HIV diagnosis in the HAART era (OR 0.34, 95% CI 0.15-0.76, p = 0.009) and ART use (OR 0.58, 95% CI 0.44-0.77, p < 0.001). In both periods bacterial infections represented the most common opportunistic events (58.6 vs. 34.7%; p < 0.001), followed by Pneumocystis jirovecii pneumonia (21.9 vs. 13.2%; p < 0.001), and bacterial meningitis/sepsis (16.8 vs. 7.4%; p < 0.001).
  
  
  CONCLUSIONS
  Despite the significant reduction in recent years, opportunistic illnesses are still common in Brazilian children with AIDS in the HAART era, especially bacterial diseases. The data reinforce the need for scaling up prevention of MTCT, early diagnosis of infection, and improvement of comprehensive pediatric care.
authors.affiliation: Department of Community Health, School of Medicine, Federal University of Ceará, Rua Professor Costa Mendes 1608, 5° andar-Bloco Didático-Rodolfo Teófilo; CE-CEP: 60430-140, Fortaleza, Ceará, Brazil. heukelbach@web.de.
authors.forename: Alberto N
authors.initials: AN
authors.lastname: Ramos
authors.forename: Luiza H
authors.initials: LH
authors.lastname: Matida
authors.forename: Norman
authors.initials: N
authors.lastname: Hearst
authors.forename: Jorg
authors.initials: J
authors.lastname: Heukelbach