Incidence of Opportunistic and Other Infections in HIV-Infected Children in the HAART Era
'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 HIV-infected children and adults, the authors wrote.
They undertook the current study to estimate the incidence of 29 targeted opportunistic and other infections occurring in the era of HAART, between Jan. 1, 2001 and Dec. 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 and pre-HAART eras and to test for linear trends over time in the HAART era. PACTG 219C is an ongoing, multicenter, prospective cohort study designed to examine long-term outcomes in HIV-infected children.
The study population included 2,767 children enrolled between Sept. 15, 2000, and Dec. 31, 2004, with data entered up to Aug. 1, 2005, when analysis was conducted. The pre-HAART comparison population included 3,331 children enrolled in 13 PATCG protocols from October 1988 to August 1998. The study's main outcome measure was the first occurrence of each of the 29 targeted infections.
Seventy-five percent of the children were enrolled in 2000-01; 90 percent acquired HIV perinatally; 59 percent were black; 52 percent were female. The median age of the study subjects was 8.2 years; the age range was 6-13 years. Median follow-up duration was 3.4 years. Fourteen percent (395) of study participants experienced 553 first episodes of a specific infection. The number of events for the four most common first-time infections and their incidence rates (IRs) per 100 person-years were 123 bacterial pneumonia (IR, 2.15; 95 percent confidence interval [CI] 1.79-2.56); 77 herpes zoster (IR, 1.11; 95 percent CI, 0.88-1.39); 57 dermatophyte infections (IR, 0.88; 0.67-1.14); and 52 oral candidiasis (IR, 0.93; 95 percent 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 during the four calendar years. Infection rates, however, were significantly lower than those reported in the PACTG in the pre-HAART era. The pre-HAART IRs were: bacterial pneumonia, IR, 11.1; 95 percent CI, 10.3-12.0; bacteremia, IR, 3.3; 95 percent CI, 2.9-3.8; herpes zoster, IR, 2.9; 95 percent CI, 2.6-3.3; disseminated M avium complex, IR, 1.8; 95 percent CI, 1.5-2.1; P jeroveci, IR, 1.3; 95 percent CI, 1.1-1.6; oral candidiasis, IR, 1.2; 95 percent CI, 1.0-1.5; cytomegalovirus retinitis, IR, 0.5; 95 percent CI, 0.3-0.6; and tuberculosis, IR, 0.2; 95 percent CI, 0.1-0.4.
'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,' the researchers concluded. 'Continued surveillance is important to assess the long-term effect of HAART on the occurrence of opportunistic and other related infections in children.'
Journal of the American Medical Association Vol. 296; No. 3: P. 292-300
Date of Publication
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
Antiretroviral Drugs Children with HIV/AIDS Opportunistic Infections Statistics Studies or Surveys
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