Onset of clinical signs in children with HIV-1 perinatal infection

L. Galli, M. De Martino, P. A. Tovo, C. Gabiano, M. Zappa, C. Giaquinto, S. Tulisso, A. Vierucci, M. Guerra, P. Marchisio, A. Plebani, G. V. Zucotti, A. M. Martino, P. Dallacasa, M. Stegagno

Research output: Contribution to journalArticle

Abstract

Objective: To investigate the timing of onset of each clinical sign in infants and children with HIV-1 perinatal infection. Design and methods: A total of 200 HIV-l-infected children followed-up from birth were studied. Failure and conditional probabilities were estimated by the Kaplan-Meier product-limit method. Cox proportional hazard analysis was used to evaluate independently associated factors. Results of 934 seroreverters were used to calculate reference values of CD4+ cell counts and predictivity of early signs. Results: Median age at the onset of any sign was 5.2 months (range, 0.03-56 months). The probability of remaining asymptomatic was 19% [95% confidence interval (CI), 14-25.1] at 12 months and 6.1% (95% CI, 2.6-11.7) at 5 years. Lymphadenopathy (69.5%), splenomegaly (62.4%) and hepatomegaly (58.4%) were the most common signs in the first year of life. Peculiar to the first year of life (compared with subsequent ages) was the onset of primary HIV-1 hepatitis and diarrhoea (rate ratios, 23.3 and 15.2, respectively). When CD4+ cell counts in the asymptomatic stage (age, 2 months; range, 0.03-5.9 months) were below rather than above the fifth percentile in seroreverters, onset of signs was earlier [3 (range, 0.03-19) versus 5 (range, 0.03-56) months]. Children manifesting signs before the 5.2-month breakpoint had a lower survival rate [74% (range, 65.9-82%) at 12 months and 45% (range, 32.9-57%) at 5 years] than children manifesting signs later [98% (range, 92.2-100%) at 12 months and 74% (range, 60.3-87.7%) at 5 years]. Children whose birthweight was ≤ 2400g had an earlier onset (24 months; range, 1-57 months) of severe conditions than children with higher birthweight (71 months; range, 1-71 months). Development of lymphadenopathy or hepatosplenomegaly within 3 months of life were reliable indicators of infection. Conclusions: This study describes the sequence of onset of signs in perinatal HIV-1 infection. Infection is shown to progress faster than in adults and in a different manner. Low birthweight, early decreased CD4+ cell counts, and early onset of signs are predictive of rapid progression.

Original languageEnglish
Pages (from-to)455-461
Number of pages7
JournalAIDS (London, England)
Volume9
Issue number5
Publication statusPublished - 1995

Keywords

  • CD4+ cell
  • Onset of signs
  • Perinatal HIV-1 infection
  • Survival

ASJC Scopus subject areas

  • Immunology
  • Immunology and Allergy

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    Galli, L., De Martino, M., Tovo, P. A., Gabiano, C., Zappa, M., Giaquinto, C., Tulisso, S., Vierucci, A., Guerra, M., Marchisio, P., Plebani, A., Zucotti, G. V., Martino, A. M., Dallacasa, P., & Stegagno, M. (1995). Onset of clinical signs in children with HIV-1 perinatal infection. AIDS (London, England), 9(5), 455-461.