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)

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. Children...

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Bibliographic Details
Published in:Pediatrics (Evanston) 2008-05, Vol.121 (5), p.e1229-e1239
Main Authors: Kapogiannis, Bill G, Soe, Minn M, Nesheim, Steven R, Sullivan, Kevin M, Abrams, Elaine, Farley, John, Palumbo, Paul, Koenig, Linda J, Bulterys, Marc
Format: Article
Language:English
Subjects:
Adolescent
AIDS-Related Opportunistic Infections - epidemiology
Antiretroviral drugs
Antiretroviral Therapy, Highly Active
Bacteremia - complications
Bacteremia - epidemiology
Bacteremia - microbiology
Blood diseases
Child
Child, Preschool
Children & youth
Drug therapy
Female
HIV
HIV Infections - complications
HIV Infections - drug therapy
HIV Infections - mortality
Human immunodeficiency virus
Humans
Incidence
Infant
Kaplan-Meier Estimate
Male
Pediatrics
Pneumococcal Infections - complications
Pneumococcal Infections - epidemiology
Streptococcus pneumoniae
Studies
United States - epidemiology
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Summary: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. 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. 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
ISSN:0031-4005
1098-4275
DOI:10.1542/peds.2007-0871