Severe, rapidly progressive human immunodeficiency virus type 1 disease in newborns with coinfections

Pediatr Infect Dis J. 2001 Apr;20(4):404-10. doi: 10.1097/00006454-200104000-00007.

Abstract

Aim: To describe a severe form of rapidly progressive HIV-1 infection manifesting in the neonatal period.

Method: Prospective cohort study, King Edward VIII Hospital, Durban, South Africa. HIV-1-exposed neonates with hepatosplenomegaly, lymphadenopathy or persistent pneumonia within the first 28 days of life were investigated for perinatal infections. Confirmation of neonatal HIV-1 infection, HIV-1 subtype and clinical outcomes were studied.

Results: Twenty-three (72%) of 32 symptomatic HIV-1-exposed neonates recruited at a mean of 15.2 days were HIV-1-infected. HIV-1 infection was detected in 5 patients who were tested within 48 h of birth, confirming congenital infection. Congenital infection was not excluded in any case. Median neonatal viral load at recruitment was 471,932 copies/ml and median CD4 was 777 cells/mm3. The predominant clinical presentation was growth retardation and prematurity. Perinatal infections detected included: tuberculosis (8), syphilis (6) and cytomegalovirus (10). All of the neonates with perinatal tuberculosis were HIV-1-coinfected. Maternal and neonatal viral load and CD4 at recruitment were not statistically different between the groups with tuberculosis vs. other coinfections. Gag gene sequence analysis confirmed closely aligned HIV-1 subtype C in mothers and neonates. Nineteen (83%) died by 9 months, with a mean age at death of 3.5 months.

Conclusions: A distinct group of HIV-1-infected babies may clinically manifest in the neonatal period with perinatal coinfections, subsequent rapidly progressive HIV-1 and early death.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • AIDS-Related Opportunistic Infections*
  • Cytomegalovirus Infections / complications
  • Developing Countries
  • HIV Infections / congenital*
  • HIV Infections / diagnosis
  • HIV Infections / physiopathology*
  • HIV Infections / transmission
  • HIV-1* / genetics
  • Humans
  • Infant, Newborn
  • Infectious Disease Transmission, Vertical
  • Prospective Studies
  • Syphilis / complications
  • Tuberculosis / complications