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. 2015 Aug 18;10(8):e0135375.
doi: 10.1371/journal.pone.0135375. eCollection 2015.

Severe Infections in HIV-Exposed Uninfected Infants Born in a European Country

Catherine Adler  1 , Edwige Haelterman  2 , Patricia Barlow  3 , Arnaud Marchant  4 , Jack Levy  1 , Tessa Goetghebuer  1
Affiliations

Severe Infections in HIV-Exposed Uninfected Infants Born in a European Country

Catherine Adler et al. PLoS One. .

Abstract

Background: Several 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.

Methods: This 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.

Results: The 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).

Conclusions: In 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.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Occurrence of severe infections during the first year of life according to period of birth & exposure to ARV during pregnancy, Kaplan-Meier survival analysis (N = 537 infants).
See this image and copyright information in PMC

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