Clement Taron-Brocard1, Jerome Le Chenadec1, Albert Faye2, Catherine Dollfus3, Tessa Goetghebuer4, Vincent Gajdos5, Jean-Marc Labaune6, Anais Perilhou1, Laurent Mandelbrot7, Stephane Blanche8, Josiane Warszawski9. 1. CESP INSERM U1018 - Univ Paris-Sud, Le Kremlin-Bicetre. 2. Univ Diderot Paris 7 AP-HP Hôpital Robert Debré 3. AP-HP Hôpital Trousseau, Paris, France. 4. CHU St Pierre, Brussels, Belgium. 5. CESP INSERM U1018 - Univ Paris-Sud, Le Kremlin-Bicetre AP-HP Hôpital Antoine Béclère, Clamart Univ Paris-Sud. 6. Hôpital de la Croix Rousse, Lyon. 7. CESP INSERM U1018 - Univ Paris-Sud, Le Kremlin-Bicetre Univ Diderot Paris 7 AP-HP Hôpital Louis Mourier, Colombes. 8. AP-HP Hôpital Necker EA 3620 Univ Paris Descartes 5. 9. CESP INSERM U1018 - Univ Paris-Sud, Le Kremlin-Bicetre Univ Paris-Sud AP-HP Hôpital Bicetre, Paris, France.
Abstract
BACKGROUND: Morbidity and mortality are higher among human immunodeficiency virus (HIV) exposed but uninfected (HEU) infants than unexposed infants, particularly if the mother had a low CD4 count. We investigated the possible association between maternal immune depression during pregnancy and the risk of infection in HEU infants in the national French Perinatal Cohort (EPF). METHODS: All neonates, born alive, to HIV-1-infected women enrolled in the EPF between 2002 and 2010 were included. The primary outcome was the first serious (hospitalization or death) infection during the first year of life. The main exposure variable was maternal CD4 cell count near delivery. The Kaplan-Meier method and multivariate Cox models were applied, with the different types of infections managed as competing events. RESULTS: Among 7638 HEU neonates, 699 had at least 1 serious infection (of which 159 were bacterial) with a Kaplan-Meier probability of 9.3% (95% confidence interval, 8.7-10.0) at 1 year. The risk of serious bacterial infection during the first year of life significantly increased with lower maternal CD4 cell count, before and after adjustment for maternal CD4 cell count <350 and 350-499 CD4/mm(3) (adjusted hazard ratio = 1.7 [1.2-2.6] and 1.2 [0.8-1.9], respectively; P = .03). This association mainly concerned infections involving encapsulated bacteria (P = .03). The risk of serious viral infection was, by contrast, independent of the mother's CD4 cell count. CONCLUSIONS: Maternal CD4 count is significantly and specifically associated with the risk of serious infections with encapsulated bacteria in HEU infants.
BACKGROUND: Morbidity and mortality are higher among human immunodeficiency virus (HIV) exposed but uninfected (HEU) infants than unexposed infants, particularly if the mother had a low CD4 count. We investigated the possible association between maternal immune depression during pregnancy and the risk of infection in HEU infants in the national French Perinatal Cohort (EPF). METHODS: All neonates, born alive, to HIV-1-infectedwomen enrolled in the EPF between 2002 and 2010 were included. The primary outcome was the first serious (hospitalization or death) infection during the first year of life. The main exposure variable was maternal CD4 cell count near delivery. The Kaplan-Meier method and multivariate Cox models were applied, with the different types of infections managed as competing events. RESULTS: Among 7638 HEU neonates, 699 had at least 1 serious infection (of which 159 were bacterial) with a Kaplan-Meier probability of 9.3% (95% confidence interval, 8.7-10.0) at 1 year. The risk of serious bacterial infection during the first year of life significantly increased with lower maternal CD4 cell count, before and after adjustment for maternal CD4 cell count <350 and 350-499 CD4/mm(3) (adjusted hazard ratio = 1.7 [1.2-2.6] and 1.2 [0.8-1.9], respectively; P = .03). This association mainly concerned infections involving encapsulated bacteria (P = .03). The risk of serious viral infection was, by contrast, independent of the mother's CD4 cell count. CONCLUSIONS: Maternal CD4 count is significantly and specifically associated with the risk of serious infections with encapsulated bacteria in HEU infants.
Authors: Adriana Weinberg; Marisa M Mussi-Pinhata; Qilu Yu; Rachel A Cohen; Volia C Almeida; Fabiana R Amaral; Laura Freimanis; Donald Robert Harris; Christiana Smith; George Siberry Journal: AIDS Res Hum Retroviruses Date: 2018-04-23 Impact factor: 2.205
Authors: Zaneta D Musimbi; Martin K Rono; James R Otieno; Nelson Kibinge; Lynette Isabella Ochola-Oyier; Etienne Pierre de Villiers; Eunice W Nduati Journal: Sci Rep Date: 2019-12-02 Impact factor: 4.379
Authors: Sarah M Labuda; Yanling Huo; Deborah Kacanek; Kunjal Patel; Krista Huybrechts; Jennifer Jao; Christiana Smith; Sonia Hernandez-Diaz; Gwendolyn Scott; Sandra Burchett; Fatima Kakkar; Ellen G Chadwick; Russell B Van Dyke Journal: Clin Infect Dis Date: 2020-07-11 Impact factor: 9.079