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)
| Autor: | Paul Palumbo, Kevin M. Sullivan, Linda J. Koenig, Minn Minn Soe, Marc Bulterys, John Farley, Bill G. Kapogiannis, Steven Nesheim, Elaine J. Abrams |
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| Rok vydání: | 2008 |
| Předmět: |
Male
medicine.medical_specialty Pediatrics Adolescent Bacteremia HIV Infections Kaplan-Meier Estimate Rate ratio medicine.disease_cause Pneumococcal Infections Acquired immunodeficiency syndrome (AIDS) Antiretroviral Therapy Highly Active Streptococcus pneumoniae Medicine Humans Child Survival analysis AIDS-Related Opportunistic Infections business.industry Proportional hazards model Transmission (medicine) Incidence (epidemiology) Incidence Infant bacterial infections and mycoses medicine.disease United States Surgery Child Preschool Pediatrics Perinatology and Child Health Female business |
| Zdroj: | Pediatrics. 121(5) |
| ISSN: | 1098-4275 |
| Popis: | OBJECTIVE. HIV-infected children are at high risk for bacteremia. Highly active antiretroviral therapy has reduced rates of opportunistic infections; less is known about its effect on pediatric bacteremia rates. Thus, we sought to determine its impact on bacteremia incidence in HIV-infected children. METHODS. Children born during 1986–1998 were followed until 2004 in the Perinatal AIDS Collaborative Transmission Study. We determined the pre–and post–highly active antiretroviral therapy (before and after January 1, 1997) incidence of bacteremia among HIV-infected children and characterized the CD4% temporal declines and mortality among patients with and those without incident bacteremias. RESULTS. Among 364 children, 68 had 118 documented bacteremias, 97 before and 21 after January 1, 1997. Streptococcus pneumoniae constituted 56 (58%) pre–and 13 (62%) post–highly active antiretroviral therapy cases. The incidence rate ratio of bacteremias comparing post–versus pre–highly active antiretroviral therapy was 0.3 overall and 0.2, 0.2, and 0.4 among children aged 0 to 24, 25 to 48, and 49 to 72 months, respectively. Kaplan-Meier analysis for time to first bacteremia in children born during the pre–highly active antiretroviral therapy compared with the post–highly active antiretroviral therapy era revealed that 69% and 94%, respectively, remained bacteremia free at a median follow-up of 6 years. The Cox proportional hazards model also showed a significant reduction of bacteremias in the post–highly active antiretroviral therapy era, even after controlling for gender and race. Among children CONCLUSIONS. A significant decrease in bacteremia incidence and a prolongation in the time to first bacteremia incident were seen in the post–highly active antiretroviral therapy era. Children with a steeper decline of CD4 T cells were more likely to develop bacteremia. Children who experienced bacteremia had an associated higher mortality than their bacteremia-free counterparts. |
| Databáze: | OpenAIRE |
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