Changing patterns of clinical events in perinatally HIV-1-infected children during the era of HAART

Abstract

Progressive reductions of both mortality and rates of class B and C clinical events, including organ complications, were evidenced in the HAART era. Nevertheless, severe bacterial infections, particularly pneumonia, still occurred at considerable high rates, even in the absence of a severe CD4 cell depletion.

Opportunistic illnesses in Brazilian children with AIDS: results from two national cohort studies, 1983-2007

“…However we identified a persisting relative importance of some specific events such as invasive bacterial diseases. A study conducted in Italy in a cohort of 1,402 children exposed to HIV through MTCT and representative of the pre-HAART (1985-1995) and HAART (1996-2000 and 2001-2005) periods showed the progressive reduction in the rate of specific clinical events, similar to our study with persisting high rates of serious bacterial infections, particularly pneumonia [11]. In Brazil, a previous study conducted in Minas Gerais State (Southeast region) in a referral center showed that the effectiveness of HAART was associated with significant reduction in the incidence of opportunistic infections in 371 children observed between 1989 and 2003 [18].…”

“…In our study cryptosporidiosis was significantly reduced (more than five times), as observed in other studies [11,29]. For other diseases (excluding cryptococcosis), despite the indication of reduction in the proportion of cases in the second period, there was not a significant difference between the periods.…”

“…However, few population-based studies have evaluated changes in the pattern of occurrence of diseases associated with HIV/AIDS [11,18,28,29]. Our data show a significant reduction in occurrence of all opportunistic illness in the HAART era: children that were born, or diagnosed with HIV/AIDS or had ART initiation after 1996 consistently and significantly reducing the chances of having opportunistic illness.…”

“…Early diagnosis of HIV infection and HAART has led to a reduction in the frequency of opportunistic diseases in children with subsequent reduced number of hospitalizations [4,8-10]. However, severe bacterial infections, mostly pneumonia, were still observed, even in children without severe immunosuppression [11]. …”

Profile of HIV infected children: A hospital based study at Eastern Nepal

“…Introduction of antiretroviral treatment ( ART) has decreased mortality and progression to advanced human immunodeficiency virus (AIDS) in perinatally HIV-infected children, but information on modification of the rate of specific clinical events is limited [4] . Understanding the epidemiology of paediatric HIV infection and progression of disease may reveal opportunities to reduce and perhaps eliminate perinatal transmission in resource poor settings; and when prevention is not possible, identification of infected children will allow appropriate treatment to significantly improve their quality of life.…”