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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Trends in opportunistic infections in the pre- and post-highly active antiretroviral therapy eras among HIV-infected children in the perinatal AIDS collaborative transmission study, 1986-2004
Pediatrics, Volume 120, No. 1, Year 2007
Notification
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Description
OBJECTIVE. We sought to determine the impact of highly active antiretroviral therapy on the incidence and prevalence of opportunistic infections in HIV-infected children. METHODS. Children born from 1986 to 1998 were monitored until 2004 in the Perinatal AIDS Collaborative Transmission Study, sponsored by the Centers for Disease Control and Prevention. We determined the pre-highly active antiretroviral therapy and post- highly active antiretroviral therapy (before and after January 1, 1997, respectively) incidence rates of opportunistic infections among HIV-infected children and characterized the temporal decreases in percentages of CD4+ cells and the mortality rates among patients with and those without incident opportunistic infections. RESULTS. The overall opportunistic infection incidence declined from 14.4 to 1.1 cases per 100 patient-years; statistically significant reductions were seen in the incidence of the most common opportunistic infections, including Pneumocystis jiroveci pneumonia (5.8 vs 0.3 cases per 100 patient-years), recurrent bacterial infections (4.7 vs 0.2 cases per 100 patient-years), extraocular cytomegalovirus infection (1.4 vs 0.1 cases per 100 patient-years), and disseminated nontuberculous mycobacterial infection (1.3 vs 0.2 cases per 100 patient-years). Kaplan-Meier analysis of time from birth to the first opportunistic infection illustrated more-rapid acquisition of opportunistic infections by HIV-infected children born in the pre-highly active antiretroviral therapy era than by those born later. In the first 3 years of life, there was a faster decline in the percentage of CD4+ cells among children with opportunistic infections. The mortality rate was significantly higher among children with opportunistic infections. CONCLUSIONS. Reduction in the incidence of opportunistic infections and prolongation of the time to the first opportunistic infection were noted during the post-highly active antiretroviral therapy era. Children who experienced opportunistic infections had higher mortality rates than did those who did not. Younger children (<3 years) who experienced opportunistic infections had faster declines in percentages of CD4+ T cells. Copyright © 2007 by the American Academy of Pediatrics.
Authors & Co-Authors
Nesheim, Steven R.
United States, Atlanta
Emory University School of Medicine
Kapogiannis, Bill G.
United States, Atlanta
Emory University School of Medicine
United States, Bethesda
National Institute of Child Health and Human Development Nichd
Soe, Minn M.
United States, Atlanta
Rollins School of Public Health
Sullivan, Kevin M.
United States, Atlanta
Rollins School of Public Health
Abrams, Elaine J.
United States, New York
Harlem Hospital Center
Farley, John J.
United States, Baltimore
University of Maryland, Baltimore Umb
Palumbo, Paul E.
United States, Newark
Rutgers Biomedical and Health Sciences
Koenig, Linda J.
United States, Atlanta
National Center for Hiv, Viral Hepatitis, Std, and tb Prevention
Bulterys, Marc G.
United States, Atlanta
National Center for Hiv, Viral Hepatitis, Std, and tb Prevention
Zambia, Lusaka
Cdc Global Aids Program
Statistics
Citations: 104
Authors: 9
Affiliations: 8
Identifiers
Doi:
10.1542/peds.2006-2052
ISSN:
00314005
e-ISSN:
02105721
Research Areas
Health System And Policy
Infectious Diseases
Maternal And Child Health
Study Design
Cross Sectional Study
Cohort Study