Relation of the Course of HIV Infection in Children to the Severity of the Disease in Their Mothers at Delivery
Stephane Blanche, Marie-Jeanne Mayaux, Christine Rouzioux, Jean-Paul Teglas, Ghislaine Firtion, Fabrice Monpoux, Nicole Cicaru-Vigneron, Francoise Meier, Joelle Tricoire, Christian Courpotin, Etienne Vilmer, Claude Griscelli, Jean-Francois Delfraissy, for The French Pediatric HIV Infection Study Group
Background Among infants with maternally transmitted human immunodeficiencyvirus (HIV) infection, there are two patterns of disease progression.In about a fifth of these infants there is a rapid progressionto profound immunodeficiency, whereas in the majority the diseaseprogresses much more slowly.
Methods We studied the clinical and biologic characteristicsof the mothers of infants infected with HIV type 1 (HIV-1) inthe French Prospective Multicenter Cohort. Infection in thechildren was confirmed by serologic tests at the age of 18 monthsor by death from the acquired immunodeficiency syndrome at anearlier age. Only the 162 infected infants who could be followedfor at least 18 months or until death were included in the analysis.
Results The risk of opportunistic infections or encephalopathyin the first 18 months was 50 percent in the infants of motherswith class IV disease, according to the Centers for DiseaseControl and Prevention classification, and 14 percent in theinfants of mothers with class II or III disease (relative risk,3.6; 95 percent confidence interval, 1.8 to 7.3; P<0.002).Forty-four percent of the former infants and 9 percent of thelatter died before 18 months (relative risk, 4.7; 95 percentconfidence interval, 2.1 to 10.4; P<0.002). The risk of deathcorrelated inversely with the mother's CD4+ cell count and directlywith her HIV-1 p24 antigen level at delivery. There was alsoa direct correlation between the mother's CD4+ cell count andthat of the infant at one, three, and nine months of age (correlationcoefficient at nine months [n = 44], 0.48; P<0.002). HIV-1p24 antigen was detected more often in the infants whose mothersalso had the antigen.
Conclusions In infants whose HIV infection is maternally acquired,the rate of disease progression varies directly with the severityof the disease in the mother at the time of delivery.
Source Information
From the Unite d'Immunologie-Hematologie Pediatrique, INSERM Unite 132 (S.B., C.G.), and the Laboratoire de Virologie (C.R.), Hopital Necker Enfants Malades; and INSERM Unite 292-Sante Publique, Epidemiologie, Reproduction Humaine, Hopital Bicetre (M.-J.M., J.-P.T.) -- both in Paris. A complete list of participants in the French Pediatric HIV Infection Study Group appears in the Appendix.
Address reprint requests to Dr. Blanche at Hopital Necker Enfants Malades, Unite d'Immunologie-Hematologie Pediatrique, 149, rue de Sevres, 75743 Paris CEDEX 15, France.
HIV-1 in Newborns
Speiser D. E., Wyler C.-A., Siegrist C.-A., Blanche S., Mayaux M.-J., Rouzioux C.
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N Engl J Med 1994;
330:1905-1906, Jun 30, 1994.
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