title: Increased risk of serious bacterial infections due to maternal immunosuppression in HIV-exposed uninfected infants in a European country.
abstract: BACKGROUND
  Morbidity and mortality are higher among human immunodeficiency virus (HIV) exposed but uninfected (HEU) infants than unexposed infants, particularly if the mother had a low CD4 count. We investigated the possible association between maternal immune depression during pregnancy and the risk of infection in HEU infants in the national French Perinatal Cohort (EPF).
  
  
  METHODS
  All neonates, born alive, to HIV-1-infected women enrolled in the EPF between 2002 and 2010 were included. The primary outcome was the first serious (hospitalization or death) infection during the first year of life. The main exposure variable was maternal CD4 cell count near delivery. The Kaplan-Meier method and multivariate Cox models were applied, with the different types of infections managed as competing events.
  
  
  RESULTS
  Among 7638 HEU neonates, 699 had at least 1 serious infection (of which 159 were bacterial) with a Kaplan-Meier probability of 9.3% (95% confidence interval, 8.7-10.0) at 1 year. The risk of serious bacterial infection during the first year of life significantly increased with lower maternal CD4 cell count, before and after adjustment for maternal CD4 cell count <350 and 350-499 CD4/mm(3) (adjusted hazard ratio = 1.7 [1.2-2.6] and 1.2 [0.8-1.9], respectively; P = .03). This association mainly concerned infections involving encapsulated bacteria (P = .03). The risk of serious viral infection was, by contrast, independent of the mother's CD4 cell count.
  
  
  CONCLUSIONS
  Maternal CD4 count is significantly and specifically associated with the risk of serious infections with encapsulated bacteria in HEU infants.
authors: CESP INSERM U1018 - Univ Paris-Sud, Le Kremlin-Bicetre.
authors: Clement
authors: C
authors: Taron-Brocard
authors: CESP INSERM U1018 - Univ Paris-Sud, Le Kremlin-Bicetre.
authors: Jerome
authors: J
authors: Le Chenadec
authors: Univ Diderot Paris 7 AP-HP Hôpital Robert Debré
authors: Albert
authors: A
authors: Faye
authors: AP-HP Hôpital Trousseau, Paris, France.
authors: Catherine
authors: C
authors: Dollfus
authors: CHU St Pierre, Brussels, Belgium.
authors: Tessa
authors: T
authors: Goetghebuer
authors: CESP INSERM U1018 - Univ Paris-Sud, Le Kremlin-Bicetre AP-HP Hôpital Antoine Béclère, Clamart Univ Paris-Sud.
authors: Vincent
authors: V
authors: Gajdos
authors: Hôpital de la Croix Rousse, Lyon.
authors: Jean-Marc
authors: JM
authors: Labaune
authors: CESP INSERM U1018 - Univ Paris-Sud, Le Kremlin-Bicetre.
authors: Anais
authors: A
authors: Perilhou
authors: CESP INSERM U1018 - Univ Paris-Sud, Le Kremlin-Bicetre Univ Diderot Paris 7 AP-HP Hôpital Louis Mourier, Colombes.
authors: Laurent
authors: L
authors: Mandelbrot
authors: AP-HP Hôpital Necker EA 3620 Univ Paris Descartes 5.
authors: Stephane
authors: S
authors: Blanche
authors: CESP INSERM U1018 - Univ Paris-Sud, Le Kremlin-Bicetre Univ Paris-Sud AP-HP Hôpital Bicetre, Paris, France.
authors: Josiane
authors: J
authors: Warszawski
mesh_terms: D001424:Bacterial Infections / Q000139:chemically induced / Q000453:epidemiology*; D018791:CD4 Lymphocyte Count; D005260:Female; D005602:France / Q000453:epidemiology; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D007223:Infant; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000139:chemically induced / Q000453:epidemiology*; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D053208:Kaplan-Meier Estimate; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control; D012189:Retrospective Studies
chemical_list: D007166:Immunosuppressive Agents
keywords: CD4; HIV; infants; mother-to-child transmission; pregnancy