High Incidence of Invasive Group B Streptococcal Infections in Human Immunodeficiency Virus-Exposed Uninfected Infants

Abstract

Several reports from resource poor African and Latin American countries suggest an increased susceptibility of human immunodeficiency virus (HIV)-exposed uninfected (HEU) infants to infection as compared with their HIV-unexposed counterparts. Many of these studies were conducted in sub-Saharan Africa, where access to adequate prophylactic antiretroviral therapy is limited. Increased susceptibility of HEU infants to infection is unlikely in more affluent, high-resource countries. This report compared the clinical presentation and incidence of severe group B streptococcal (GBS) infections during the first months of life in a cohort of infants born to HIV-infected and -uninfected mothers at a university hospital in Belgium. The hospital database and microbiology laboratory records were used to identify all HEU infants born between 2001 and 2008 with invasive GBS infections at follow-up. The control group consisted of infants born to HIV-uninfected mothers. Invasive GBS infections developed in 5 (1.55%) of HEU infants who were born to the 322 HIV-uninfected mothers, and in only 16 (0.08%) of the control infants born to 20, 158 HIV-uninfected mothers. Moreover, late-onset infection occurred more frequently among HEU infants (HEU group: 5 of 6 [83%] vs. control group: 2 of 16 [13%], P < 0.04). Infections were more severe in HEU infants: septic shock or sepsis occurred in 5 of 6 HEU infants versus 10 of 16 controls, and leukopenia occurred more frequently at onset of infection in HEU infants (66% vs. 13%). One HEU infant presenting with a recurrent GBS infection 28 days after the completion of treatment for the first episode developed septic shock with meningitis resulting in death. The findings show that HEU infants have a significantly higher incidence of GBS infection and more late-onset and severe disease as compared with the infants born to HIV-uninfected mothers. These are the first data obtained from a developed country suggesting an increased susceptibility of HEU infants to GBS infection.