Published online July 2, 2007
PEDIATRICS Vol. 120 No. 1 July 2007, pp. 100-109 (doi:10.1542/10.1542/peds.2006-2052)
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ARTICLE

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

Steven R. Nesheim, MDa, Bill G. Kapogiannis, MDa,b, Minn M. Soe, MD, MPHc, Kevin M. Sullivan, PhD, MPHc, Elaine Abrams, MDd, John Farley, MD, MPHe, Paul Palumbo, MDf, Linda J. Koenig, PhDg and Marc Bulterys, MD, PhDg

a Departments of Pediatrics
b Medicine, Division of Infectious Diseases, Emory University School of Medicine
c Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
d Department of Pediatrics, Harlem Hospital Center, New York, New York
e Department of Pediatrics, University of Maryland, Baltimore, Maryland
f Department of Pediatrics, University of Medicine and Dentistry of New Jersey, Newark, New Jersey
g Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia

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.

Key Words: pediatric HIV/AIDS • opportunistic infections • highly active antiretroviral therapy

Abbreviations: CDC—Centers for Disease Control and Prevention • CMV—cytomegalovirus • HAART—highly active antiretroviral therapy • NTM—nontuberculous mycobacteria • OI—opportunistic infection • PACTG—Pediatric AIDS Clinical Trials Group • PACTS—Perinatal AIDS Collaborative Transmission Study • PACTS-HOPE—Perinatal AIDS Collaborative Transmission Study-HIV Follow-up after Perinatal Exposure • PCP—Pneumocystis jiroveci pneumonia • PSD—Pediatric Spectrum of Disease • RBI—recurrent bacterial infection

Accepted Mar 7, 2007.


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