Lower respiratory tract infections among human immunodeficiency virus-exposed, uninfected infants

Mussi-Pinhata, Marisa Márcia; Motta, Fabrízio; Freimanis-Hance, Laura; Souza, Ricardo de; Szyld, Edgardo; Succi, Regina C.M.; Christie, Celia D. C.; Rolón, María José; Ceriotto, Mariana; Read, Jennifer S.

doi:10.1016/j.ijid.2010.01.006

Cited by 40 publications

(36 citation statements)

References 27 publications

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“…Several HEU studies have noted an association between maternal CD4 and infant hospitalization, [1, 14] mortality [14, 25] and lower respiratory tract infection [26]. We observed an association between maternal HIV viral load and infant pneumonia, but not with CD4, consistent with a South African study [27].…”

Section: Discussionsupporting

confidence: 90%

Breastfeeding is associated with decreased pneumonia incidence among HIV-exposed, uninfected Kenyan infants

Ásbjörnsdóttir¹,

Slyker²,

Weiss³

et al. 2013

Aids

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Objective HIV-exposed uninfected infants (HEU) have higher infectious disease morbidity and mortality than unexposed infants. We determined the incidence and risk factors for pneumonia, a leading cause of infant mortality worldwide, in a cohort of HEU infants. Identifying predictors of pneumonia among HEU infants may enable early identification of those at highest risk. Design A retrospective cohort of HEU participating in a Kenyan perinatal HIV study, enrolled between 1999-2002. Methods Infants were followed monthly from birth to 12 months. Incidence of pneumonia diagnosed at monthly study visits, sick-child visits or by means of a verbal autopsy, was estimated with a 14-day window for new episodes. Cox proportional hazards regression was used to identify predictors of first pneumonia occurrence. Results Among 388 HEU infants with 328 person-years of follow-up, the incidence of pneumonia was 900/1,000 child-years (95% CI: 800-1,000). Maternal HIV viral load at 32 weeks gestation [HR=1.2 (1.0-1.5) per log10 difference] and being underweight (weight-for-age Z-score <-2) at the previous visit [HR=1.8 (1.1-2.8)] were associated with increased risk of pneumonia. Breastfed infants had a 47% lower risk of pneumonia than those never breastfed [HR=0.53 (0.39-0.73)], independent of infant growth, maternal viral load and maternal CD4%. Breastfeeding was also associated with a 74% lower risk of pneumonia-related hospitalization (HR=0.26 (0.13-0.53)). Conclusions The incidence of pneumonia in this cohort of HEU infants was high. Our observations suggest that maternal viral suppression and breastfeeding may reduce the burden of pneumonia among HEU.

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Section: Discussionsupporting

confidence: 90%

Breastfeeding is associated with decreased pneumonia incidence among HIV-exposed, uninfected Kenyan infants

Ásbjörnsdóttir¹,

Slyker²,

Weiss³

et al. 2013

Aids

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“…Studies have noted the burden of respiratory tract infections in HEU infants, but without HU control groups, it has not been possible to understand whether HEU infants experience morbidity as expected or morbidity in excess of expected for their context. 41–43 In Southern Africa, HEU infants have the same rate of all pneumonia as HU infants but have a greater risk for severe pneumonia and empiric pneumonia treatment failure. 8,13,16,18 Early studies observed a larger relative difference in infant mortality than in morbidity or hospitalization when comparing HEU and HU infants, possibly indicating more severe disease in HEU infants.…”

Section: Discussionmentioning

confidence: 99%

A Prospective Cohort Study of Common Childhood Infections in South African HIV-exposed Uninfected and HIV-unexposed Infants

Slogrove

Esser

Cotton

et al. 2017

Pediatric Infectious Disease Journal

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Background:Much evidence of HIV-exposed uninfected (HEU) infant infectious morbidity predates availability of maternal combination antiretroviral therapy and does not control for universal risk factors (preterm birth, low birth weight, suboptimal breastfeeding and poverty).Methods:This prospective cohort study identified HIV-infected and HIV-uninfected mothers and their newborns from South African community midwife unit. The primary outcome, infectious cause hospitalization or death before 6 months of age, was compared between HEU and HIV-unexposed (HU) infants and classified for type and severity using validated study-specific case definitions. Adjusted odds ratios (aORs) were calculated by logistic regression including stratified analyses conditioned on breastfeeding.Results:One hundred and seventy-six (94 HEU and 82 HU) mother–infant pairs were analyzed. HIV-infected mothers were older (median, 27.8 vs. 24.7 years; P < 0.01) and HU infants more often breastfed (81/82 vs. 35/94; P < 0.001). Groups were similar for maternal education, antenatal course, household characteristics, birth weight, gestational age and immunizations. The primary outcome occurred in 17 (18%) HEU and 10 (12%) HU infants [aOR, 1.45; 95% confidence interval (CI): 0.44–4.55]. In stratified analysis restricted to breastfed infants, the aOR for hospitalization due to very severe infection or death was 4.2 (95% CI: 1.00–19.2; P = 0.05) for HEU infants. Hospitalization for diarrhea was more common in HEU than HU infants [8/94 (8.5%) vs. 1/82 (1.2%); P = 0.04].Conclusion:The difference between HEU and HU infants in the probability of infectious cause hospitalization or death in the first 6 months of life was not significant. However, among breastfed infants, severe infectious morbidity occurred more often in HEU than HU infants.

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“…Respiratory syncytial virus (RSV) is the most frequent cause of lower respiratory tract infection (LRTI) in young children and by the age of 2 years, 80% of children have encountered the infection . Risk factors pre‐disposing to severe RSV‐related lower respiratory tract infection (LRTI) include prematurity, bronchopulmonary dysplasia, congenital heart disease, and immunodeficiencies . In patients with cystic fibrosis (CF) viral infections have been shown to be associated with increased hospitalization rates and decline in pulmonary function, resulting in short‐term and long‐term morbidity .…”

Section: Introductionmentioning

confidence: 99%

Efficacy and long‐term outcomes of palivizumab prophylaxis to prevent respiratory syncytial virus infection in infants with cystic fibrosis in Northern Ireland

Jenkins

MacFarlane

Reid

et al. 2016

Pediatric Pulmonology

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Summary Background RSV causes considerable morbidity and mortality in children. In cystic fibrosis (CF) viral infections are associated with worsening respiratory symptoms and bacterial colonization. Palivizumab is effective in reducing RSV hospitalization in high risk patient groups. Evidence regarding its effectiveness and safety in CF is inconclusive. CF screening in N. Ireland enabled timely palivizumab prophylaxis, becoming routine in 2002. Objectives To determine the effect of palivizumab on RSV‐related hospitalization and compare lung function and bacterial colonization at age 6 years for those born pre‐ and post‐introduction of palivizumab prophylaxis. Methods A retrospective audit was conducted for all patients diagnosed with CF during the period from 1997 to 2007 inclusive. RSV‐related hospitalization, time to Pseudomonas aeruginosa (PA) 1st isolate, lung function and growth parameters were recorded. Comparisons were made for outcomes pre‐ and post‐introduction of routine palivizumab administration in 2002. A cost evaluation was also performed. Results Ninety‐two children were included; 47 pre‐ and 45 post‐palivizumab introduction. The overall RSV‐positive hospitalization rate was 13%. The relative risk of RSV infection in palivizumab non‐recipients versus recipients was 4.78 (95%CI: 1.1–20.7), P = 0.027. Notably, PA 1st isolate was significantly earlier in the palivizumab recipient cohort versus non‐recipient cohort (median 57 vs. 96 months, P < 0.025) with a relative risk of 2.5. Chronic PA infection at 6 years remained low in both groups, with similar lung function and growth parameters. Total costs were calculated at £96,127 ($151,880) for the non‐recipient cohort versus £137,954 ($217,967) for the recipient cohort. Conclusion Palivizumab was effective in reducing RSV‐related hospitalization infection in CF patients. Surprisingly, we found a significantly earlier time to 1st isolate of PA in palivizumab recipients which we could not explain by altered or improved diagnostic tests. Pediatr Pulmonol. 2016;51:379–385. © 2016 Wiley Periodicals, Inc.

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Lower respiratory tract infections among human immunodeficiency virus-exposed, uninfected infants

Cited by 40 publications

References 27 publications

Breastfeeding is associated with decreased pneumonia incidence among HIV-exposed, uninfected Kenyan infants

Breastfeeding is associated with decreased pneumonia incidence among HIV-exposed, uninfected Kenyan infants

A Prospective Cohort Study of Common Childhood Infections in South African HIV-exposed Uninfected and HIV-unexposed Infants

Efficacy and long‐term outcomes of palivizumab prophylaxis to prevent respiratory syncytial virus infection in infants with cystic fibrosis in Northern Ireland

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