Published online February 12, 2007
PEDIATRICS Vol. 119 No. 3 March 2007, pp. e694-e704 (doi:10.1542/peds.2006-1856)
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ARTICLE

Infectious Disease Morbidity Among Young HIV-1–Exposed But Uninfected Infants in Latin American and Caribbean Countries: The National Institute of Child Health and Human Development International Site Development Initiative Perinatal Study

Marisa M. Mussi-Pinhata, MDa, Laura Freimanis, MD, PhDb, Aparecida Y. Yamamoto, MDa, James Korelitz, PhDb, Jorge A. Pinto, MDc, Maria L. S. Cruz, MDd, Marcelo H. Losso, MDe, Jennifer S. Read, MDf for the National Institute of Child Health and Human Development International Site Development Initiative Perinatal Study Group

a University of Sao Paulo, Ribeirão Preto, Sao Paulo, Brazil
b Westat, Rockville, Maryland
c Federal University of Minas Gerais, Belo Horizonte, Brazil
d Hospital dos Servidores do Estado, Rio de Janeiro, Brazil
e Hospital General de Agudos Jose Maria Ramos Mejia, Buenos Aires, Argentina
f Pediatric, Adolescent, and Maternal AIDS Branch, Center for Research for Mothers and Children, National Institute of Child Health and Human Development, Bethesda, Maryland

OBJECTIVE. The goal was to describe the frequency, characteristics, and correlates of infectious disease morbidity during the first 6 months of life among HIV-1–exposed but uninfected infants.

METHODS. The study population consisted of infants enrolled in the National Institute of Child Health and Human Development International Site Development Initiative Perinatal Study who were HIV-1 uninfected and had follow-up data through the 6-month study visit. Definitive and presumed infections were recorded at study visits (birth, 6–12 weeks, and 6 months).

RESULTS. Of 462 HIV-1–uninfected infants with 11644 child-weeks of observation, 283 experienced ≥1 infection. These 283 infants experienced 522 infections (1.8 infections per infant). The overall incidence rate of infections was 4.5 cases per 100 child-weeks of observation. Overall, the most common infections were skin or mucous membrane infections (1.9 cases per 100 child-weeks) and respiratory tract infections (1.7 cases per 100 child-weeks). Thirty-six percent of infants had >1 respiratory tract infection (1.8 cases per 100 child-weeks). Incidence rates of upper and lower respiratory tract infections were similar (0.89 cases per 100 child-weeks and 0.9 cases per 100 child-weeks, respectively). Cutaneous and/or oral candidiasis occurred in 48 neonates (10.3%) and 92 older infants (19.3%). Early neonatal sepsis was diagnosed in 12 infants (26.0 cases per 1000 infants). Overall, 81 of 462 (17.5%) infants were hospitalized with an infection. Infants with lower respiratory tract infections were hospitalized frequently (40.7%). The occurrence of ≥1 neonatal infection was associated with more-advanced maternal HIV-1 disease, tobacco use during pregnancy, infant anemia, and crowding. Lower maternal CD4+ cell counts, receipt of intrapartum antibiotic treatment, and country of residence were associated with postneonatal infections.

CONCLUSIONS. Close monitoring of HIV-1–exposed infants, especially those who are anemic at birth or whose mothers have more-advanced HIV-1 disease or who smoked during pregnancy, remains important.

Key Words: HIV-1 • infancy • infections • Latin America • Caribbean

Abbreviations: NICHD—National Institute of Child Health and Human Development • NISDI—NICHD International Site Development Initiative • OR—odds ratio • CI—confidence interval

Accepted Sep 25, 2006.