Abstract
BackgroundHAART has significantly reduced AIDS-related morbidity in children. However, limited evidence is available from developing countries regarding patterns of opportunistic illnesses. We describe these events and their associated factors in children with AIDS in Brazil.MethodsThis study is based on two representative retrospective multi-center cohorts including a total 1,859 children with AIDS, infected via mother-to-child transmission (MTCT), between 1983-2002. Opportunistic illnesses were described and analyzed over time. The association of demographic, clinical and operational data with the occurrence of opportunistic diseases was assessed.ResultsIn total, 1,218 (65.5%) had at least one event of an opportunistic disease. Variables significantly associated with occurrence of these events included: region of residence (OR 2.68-11.33, as compared to the Northern region), age < 1 year at diagnosis (OR 2.56, 95% CI 1.81-3.61, p < 0.001), and non-performance of MTCT prevention measures (OR 1.58, 95% CI 1.21-2.07, p < 0.001). Protective factors included year of HIV diagnosis in the HAART era (OR 0.34, 95% CI 0.15-0.76, p = 0.009) and ART use (OR 0.58, 95% CI 0.44-0.77, p < 0.001). In both periods bacterial infections represented the most common opportunistic events (58.6 vs. 34.7%; p < 0.001), followed by Pneumocystis jirovecii pneumonia (21.9 vs. 13.2%; p < 0.001), and bacterial meningitis/sepsis (16.8 vs. 7.4%; p < 0.001).ConclusionsDespite the significant reduction in recent years, opportunistic illnesses are still common in Brazilian children with AIDS in the HAART era, especially bacterial diseases. The data reinforce the need for scaling up prevention of MTCT, early diagnosis of infection, and improvement of comprehensive pediatric care.
Highlights
highly active antiretroviral therapy (HAART) has significantly reduced AIDS-related morbidity in children
The limited evidence available in children exposed to human immunodeficiency virus (HIV) via mother to child transmission (MTCT) shows reduced rates of clinical events in category “C” of Centers for Disease Control and Prevention (CDC) revised classification system for HIV infection
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 [4,8,9,10]
Summary
Limited evidence is available from developing countries regarding patterns of opportunistic illnesses. We describe these events and their associated factors in children with AIDS in Brazil. The adoption of highly active antiretroviral therapy (HAART) has had an important role in modifying the natural history of HIV infection in children, characterized by a reduction of the progression to AIDS. The limited evidence available in children exposed to HIV via mother to child transmission (MTCT) shows reduced rates of clinical events in category “C” of CDC revised classification system for HIV infection. 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 [4,8,9,10]. Severe bacterial infections, mostly pneumonia, were still observed, even in children without severe immunosuppression [11]
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