Severe Infections in HIV-Exposed Uninfected Infants Born in a European Country.
BACKGROUND
Several studies indicate that HIV-exposed uninfected (HEU) children have a high infectious morbidity. We previously reported an increased incidence of group B streptococcus (GBS) infections in HEU infants born in Belgium.


METHODS
This study was undertaken to evaluate the incidence and risk factors of all cause severe infections in HEU infants born in Belgium between 1985 and 2006, including the pre-antiretroviral (ARV) prophylaxis era (1985 to 1994). The medical charts of 537 HEU infants followed in a single center were reviewed.


RESULTS
The incidence rate of severe infections during the first year of life was 16.8/100 HEU infant-years. The rates of invasive S. pneumoniae (0.62/100 infant-years) and GBS infections (1.05/100 infant-years) were, respectively, 4 and 13-fold higher in HEU infants than in the general infant population. Preterm birth was a risk factor for severe infections in the neonatal period (aOR = 21.34, 95%CI:7.12-63.93) and post-neonatal period (aHR = 3.00, 95%CI:1.53-5.88). As compared to the pre-ARV prophylaxis era, infants born in the ARV prophylaxis era (i.e., after April 1994) had a greater risk of severe infections (aHR = 2.93; 95%CI:1.07-8.05). This risk excess was present in those who received ARV prophylaxis (aHR 2.01, 95%CI 0.72-5.65) and also in those born in the ARV prophylaxis era who did not benefit from ARV prophylaxis as a result of poor access to antenatal care or lack of compliance (aHR 3.06, 95%CI 0.88-10.66).


CONCLUSIONS
In HEU infants born in an industrialized country, preterm birth and being born during the ARV prophylaxis era were risk factors of severe infections throughout the first year of life. These observations have important implications for the clinical management of HIV-infected mothers and their infants.
Pediatric Department, St Pierre University Hospital, Brussels, Belgium.
Catherine
C
Adler
Clinical Investigation Unit, ImmuneHealth, Gosselies, Belgium.
Edwige
E
Haelterman
Obstetrical Department, St Pierre University Hospital, Brussels, Belgium.
Patricia
P
Barlow
Institute for Medical Immunology, Université Libre de Bruxelles (ULB), Gosselies, Belgium.
Arnaud
A
Marchant
Pediatric Department, St Pierre University Hospital, Brussels, Belgium.
Jack
J
Levy
Pediatric Department, St Pierre University Hospital, Brussels, Belgium.
Tessa
T
Goetghebuer
D000293:Adolescent; D000328:Adult; D001530:Belgium / Q000453:epidemiology; D004198:Disease Susceptibility; D005260:Female; D005865:Gestational Age; D015658:HIV Infections; D015497:HIV-1 / Q000472:pathogenicity; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008297:Male; D008431:Maternal-Fetal Exchange; D009017:Morbidity; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious; D011297:Prenatal Exposure Delayed Effects; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013290:Streptococcal Infections / Q000453:epidemiology*; D013292:Streptococcus agalactiae / Q000472:pathogenicity*; D055815:Young Adult