 |
|
Incidence of Opportunistic and Other Infections in HIV-Infected Children in the HAART Era
Philimon Gona, PhD;
Russell B. Van Dyke, MD;
Paige L. Williams, PhD;
Wayne M. Dankner, MD;
Miriam C. Chernoff, PhD;
Sharon A. Nachman, MD;
George R. Seage III, DSc, MPH
JAMA. 2006;296:292-300.
Context Combination anti-retroviral therapy or highly active antiretroviral therapy (HAART) has resulted in a dramatic decline in the incidence of opportunistic and other infections in human immunodeficiency virus (HIV)–infected adults and children.
Objectives To estimate the incidence of 29 targeted opportunistic and other infections occurring in the era of HAART—between January 1, 2001, and December 31, 2004—in HIV-infected infants, children, and adolescents followed up in Pediatric AIDS Clinical Trials Group (PACTG) 219C; to compare incidence rates in the HAART era to those of the pre-HAART era; and to test for linear trends over time in the HAART era.
Design, Setting, and Participants Ongoing, multicenter, prospective cohort study designed to examine long-term outcomes in HIV-infected children. The study population included 2767 children enrolled between September 15, 2000, and December 31, 2004, with information entered in the database up to August 1, 2005, when data analysis was conducted. The pre-HAART era comparison population included 3331 children enrolled in 13 PACTG protocols from October 1988 to August 1998.
Main Outcome Measures First occurrence of each of the 29 targeted infections.
Results Seventy-five percent of the children were enrolled in 2000 and 2001, 90% acquired HIV perinatally, 52% were girls, and 59% were black. The median age was 8.2 years (range, 6-13 years). The median duration of follow-up was 3.4 years. Overall, 553 first episodes of a specific infection occurred among 395 (14%) of the study participants. The number of events for the 4 most common first-time infections and their incidence rates (IRs) per 100 person-years were 123 bacterial pneumonia (IR, 2.15; 95% confidence interval [CI], 1.79-2.56), 77 herpes zoster (IR, 1.11; 95% CI, 0.88-1.39), 57 dermatophyte infections (IR, 0.88; 0.67-1.14), and 52 oral candidiasis (IR, 0.93; 95% CI, 0.70-1.22). Incidence rates of first bacteremia, Pneumocystis jeroveci pneumonia, disseminated Mycobacterium avium complex, lymphoid interstitial pneumonitis, systemic fungal infection, cytomegalovirus retinitis, and tuberculosis were all less than 0.50 per 100 person-years. There were no statistically significant linear trends in incidence for any of the 29 infections over the 4 calendar years. However, infection rates were significantly lower than those reported in the PACTG in the pre-HAART era. The pre-HAART IRs were as follows: for bacterial pneumonia, IR, 11.1; 95% CI, 10.3-12.0; bacteremia, IR, 3.3; 95% CI, 2.9-3.8; herpes zoster, IR, 2.9; 95% CI, 2.6-3.3; disseminated M avium complex, IR, 1.8; 95% CI, 1.5-2.1; P jeroveci, IR, 1.3; 95% CI, 1.1-1.6; oral candidiasis, IR, 1.2; 95% CI, 1.0-1.5; cytomegalovirus retinitis, IR, 0.5; 95% CI, 0.3-0.6; and tuberculosis, IR, 0.2; 95% CI, 0.1-0.4.
Conclusions Opportunistic infections and other related infections are uncommon in children in the HAART era, and infection rates continue to be lower than those reported in the pre-HAART era. Continued surveillance is important to assess the long-term effect of HAART on the occurrence of opportunistic and other related infections in children.
Author Affiliations: Center for Biostatistics in AIDS Research (Drs Gona, Williams, Chernoff, Seage) and Departments of Biostatistics (Dr Williams) and Epidemiology (Dr Seage), Harvard School of Public Health, and Department of Mathematics and Statistics and Statistical Consulting Unit, Boston University (Dr Gona), Boston, Mass; Department of Pediatrics, Tulane University Health Sciences Center, New Orleans, La (Dr Van Dyke); Department of Pediatrics, Duke University, Durham, NC (Dr Dankner); and Department of Pediatrics, State University of New York Stony Brook (Dr Nachman).
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati
What's this?
RELATED ARTICLES
Antiretroviral Therapy for Children: Substantial Benefit But Limited Access
Joseph I. Harwell and Stephen K. Obaro
JAMA. 2006;296(3):330-331.
EXTRACT
| FULL TEXT
Preventing HIV Infection in Infants and Children
Erin Brender, Cassio Lynm, and Richard M. Glass
JAMA. 2006;296(3):356.
EXTRACT
| FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Safety, Tolerability and Effectiveness of Generic HAART in HIV-Infected Children in South India
Kumarasamy et al.
J Trop Pediatr 2009;55:155-159.
ABSTRACT
| FULL TEXT
Morbidity in HIV-1-Infected Children Treated or Not Treated with Highly Active Antiretroviral Therapy (HAART), Abidjan, Cote d'Ivoire, 2000-04
Walenda et al.
J Trop Pediatr 2009;55:170-176.
ABSTRACT
| FULL TEXT
Incidence of Noninfectious Conditions in Perinatally HIV-Infected Children and Adolescents in The HAART Era
Nachman et al.
Arch Pediatr Adolesc Med 2009;163:164-171.
ABSTRACT
| FULL TEXT
Trends in Bacteremia in the Pre- and Post-Highly Active Antiretroviral Therapy Era Among HIV-Infected Children in the US Perinatal AIDS Collaborative Transmission Study (1986-2004)
Kapogiannis et al.
Pediatrics 2008;121:e1229-e1239.
ABSTRACT
| FULL TEXT
Primary Varicella and Herpes Zoster Among HIV-Infected Children From 1989 to 2006
Wood et al.
Pediatrics 2008;121:e150-e156.
ABSTRACT
| FULL TEXT
Trends in Hospitalizations of HIV-Infected Children and Adolescents in the United States: Analysis of Data From the 1994 2003 Nationwide Inpatient Sample
Kourtis et al.
Pediatrics 2007;120:e236-e243.
ABSTRACT
| FULL TEXT
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
Nesheim et al.
Pediatrics 2007;120:100-109.
ABSTRACT
| FULL TEXT
Progress Against Opportunistic Infections in HIV-Infected Children
JWatch Infect. Diseases 2006;2006:7-7.
FULL TEXT
What's new in the other general journals
Tonks
BMJ 2006;333:249-250.
FULL TEXT
Antiretroviral therapy for children: substantial benefit but limited access.
Harwell and Obaro
JAMA 2006;296:330-331.
FULL TEXT
|
