Abstract
BackgroundSeveral 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.MethodsThis 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.ResultsThe 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).ConclusionsIn 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.
Highlights
Since 1996, administration of combined antiretroviral agents in HIV-infected pregnant women has markedly reduced the risk of mother to child transmission (MTCT) of the virus [1], leading to an increasing number of HIV-exposed uninfected infants (HEU)
We previously reported an increased incidence of group B streptococcus (GBS) infections in HEU infants born in Belgium
As compared to the pre-ARV prophylaxis era, infants born in the ARV prophylaxis era had a greater risk of severe infections
Summary
Since 1996, administration of combined antiretroviral (cARV) agents in HIV-infected pregnant women has markedly reduced the risk of mother to child transmission (MTCT) of the virus [1], leading to an increasing number of HIV-exposed uninfected infants (HEU). Several publications from developing countries reported a high infectious morbidity and mortality risk in HEU infants compared to infants born to HIV-uninfected mothers [7,8,9,10,11,12,13,14,15,16]. We recently reported a significantly increased incidence of late onset invasive group B streptococcus (GBS) infection in HEU infants as compared to the general population of HIV-unexposed infants born in Belgium [18]. These observations led us to retrospectively examine the incidence and the risk factors of all severe infections occurring in 537 HEU children born to HIV-infected mothers between 1985 and 2006 and followed in our hospital. We previously reported an increased incidence of group B streptococcus (GBS) infections in HEU infants born in Belgium
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