Objective. To compare morbidity and mortality of human immunodeficiency virus type 1 (HIV-1)-infected and HIV-1-uninfected children and to identify predictors of acquired immunodeficiency syndrome (AIDS) and death among HIV-1-infected children in the context of a developing country. Design. Prospective cohort study. Setting. Maternal and child health clinic of the Centre Hospitalier de Kigali, Rwanda. Participants. Two hundred eighteen children born to HIV-1-seropositive mothers and 218 born to seronegative mothers of the same age and parity were enrolled at birth. Outcome Measures. Deaths, clinical AIDS, nonspecific HIV-related manifestations, and use of health care services. Results. Fifty-four infected and 347 uninfected children were followed up for a median of 27 and 51 months, respectively. With the exception of chronic cough, the risk of occurrence of nonspecific HIV-related conditions was 3 to 13 times higher in infected than in uninfected children. The recurrence rate and severity of these findings were increased systematically in infected infants. Estimated cumulative risk of developing AIDS was 28% and 35% at 2 and 5 years of age, respectively. Estimated risk of death among infected children at 2 and 5 years of age was 45% and 62%, respectively, a rate 21 times higher than in uninfected children. Median survival time after estimated infection was 12.4 months. Early infection, early onset of HIV-related conditions, failure to thrive, and generalized lymphadenopathy were associated with subsequent risk of death and/or AIDS, whereas lymphoid interstitial pneumonitis was predictive of a milder disease. Conclusions. In Africa, HIV-1-infected children develop disease manifestations early in life. Specific clinical findings are predictive of HIV-1 disease, AIDS stage, and death. Bimodal expression of HIV-1 pediatric disease is encountered in Africa, as in industrialized countries, but prognosis is poorer. human immunodeficiency virus infection, children, vertical transmission, natural history, Africa.

https://pediatrics.aappublications.org/content/pediatrics/104/5/e56.full.pdf

Natural History of Human Immunodefiency Virus Type 1 Infection in Children: A Five-Year Prospective Study in Rwanda

Objective. —To compare mother-to-child transmission of human immunodeficiency virus types 1 and 2 (HIV-1 and HIV-2, respectively) and to assess the impact of maternal HIV-1 and HIV-2 infections on child survival. Design. —Prospective cohort study. Setting. —Maternal and child health center in a lower socioeconomic class district of Abidjan, Ivory Coast. Participants. —A total of 18 099 women delivering between 1990 and 1992 were tested for HIV-1 and HIV-2 antibodies. A cohort of 613 pregnant women and their infants was followed prospectively (138 women reactive to HIV-1,132 reactive to HIV-2, 69 reactive to both viruses, and 274 HIV-seronegative). Main Outcome Measures.—Rates of perinatal transmission for HIV-1, HIV-2, and both viruses, determined from results of serological and polymerase chain reaction tests on children; survival of infants born to HIV-1—positive, HIV-2—positive, dually reactive, and HIV-seronegative women. Results. —Of the 18 099 women tested, 9.4% were reactive to HIV-1 alone, 1.6% to HIV-2 alone, and 1.0% to both viruses. The rate of perinatal transmission of HIV-1 was 24.7% (95% confidence interval [CI], 15.8% to 33.7%), compared with 1.2% (95% CI, 0.0% to 3.5%) for HIV-2 (relative risk, 21.3; 95% CI, 2.9 to 154.3). Overall, 19.0% (95% CI, 9.0% to 29.0%) of infants of dually reactive women became infected; of the 11 children concerned, 10 were infected with HIV-1 and one with HIV-1 and HIV-2. Infants of HIV-seropositive mothers had a reduced survival; mortality rates were 15.1, 13.0, 6.5, and 3.4 deaths per 100 child-years, respectively, for children of HIV-1—positive, dually reactive, HIV-2—positive, and HIV-seronegative women. Conclusions. —The rate of perinatal transmission of HIV-2 (1.2%) was much lower than the rate of perinatal transmission of HIV-1 (24.7%), and this was associated with more favorable survival for infants of HIV-2—infected mothers. Dually reactive women could transmit both viruses, although transmission usually involved HIV-1 only. Public health guidelines should incorporate advice that perinatal transmission of HIV-2 is rare. ( JAMA . 1994;272:462-466)

Prospective Comparison of Mother-to-Child Transmission of HIV-1 and HIV-2 in Abidjan, Ivory Coast

Transmission of HIV-1 infection in sub-Saharan Africa and effect of elimination of unsafe injections.

AIDS has become a major burden in developing countries. At present, more than 90% of new HIV infections are emerging in Asia and Africa. Particularly ominous is the epidemic due to HIV-1 C in southern Africa, where about 25% of adults in several countries are infected. Although most of its spread apparently occurred during the 1990s, HIV-1 C currently accounts for one-half of the infections in the world. Both HIV-2, which is less virulent than HIV-1, and HIV-1 apparently spread to the human population from nonhuman African primates during the twentieth century. HIV-1 infection is usually lethal in the absence of antiretroviral therapy, but clinical disease occurs only after an induction period of several years. Some subtypes of HIV-1, such as C, E, and A, appear to be transmitted more efficiently than HIV-1 B, which is the major subtype in the United States and Europe. Molecular evolutionary changes that include receptor affinity, mediated by the env gene, and increased transcriptional activation, mediated by changes in the LTR and the tat gene, may account for some of the changes in transmission. Current therapies are prohibitively expensive for use in adults in most developing countries, although drugs for maternal-to-infant transmission are becoming accessible. A vaccine for HIV is desperately needed for the developing world.

Human immunodeficiency viruses in the developing world.

For consecutive periods between August 1991 and July 1992 all children older than 28 days and younger than 15 years admitted to the pediatric ward of Abidjans three university hospitals were examined tested for HIV infection and followed to discharge in a study conducted to determine the prevalence of HIV infection in the subpopulation and to compare diagnostic syndromes and outcomes in HIV-positive and HIV-negative children. 4667 admissions were recorded during the period which included 77 second or third admissions for 74 children. There was an 8.2% prevalence of HIV infection among the 4480 children hospitalized for the first time with the highest age-specific rate being among children aged 15-23 months. Respiratory infection malnutrition malaria anemia diarrhea and meningitis accounted for more than 80% of admissions in HIV-positive and HIV-negative children. Respiratory infection and malnutrition were the dominant syndromic diagnoses in HIV-positive children while malaria and respiratory infection prevailed among HIV-negative children. Overall mortality rates for HIV-positive and HIV-negative children were 20.8% and 8.7% respectively. The highest death rate 28.1% was among children younger than age 15 months.

Clinical spectrum of human immunodeficiency virus disease in children in a West African city.

The authors conducted a study of 1003 well and hospitalized children birth to 5 years old in Abidjan Cote dIvoire to determine the prevalence of HIV-1 and HIV-2 infection evaluate some risk factors for infection and describe associated clinical characteristics. The overall seroprevalence was significantly higher for children in the hospital (10.8%) than for those attending the clinic (1.6%). HIV-1 was the predominant virus in both populations comprising 87% (hospital) and 77% (clinic) of the seroreactive blood specimens. 92% of seroreactive children of all ages had a mother who was HIV-positive; 77% of seroreactive children >or= 15 months old had a HIV-infected mother. The remaining seropositive children had a history of receiving blood transfusions. Hospitalized children who were HIV-1 positive or dually seroreactive were more likely to have HIV-related clinical signs and symptoms than HIV-negative children. These findings suggest that HIV infection is an important cause of morbidity for children in Abidjan and that maternal infection is the primary risk factor for both HIV-1 and HIV-2 infection in children. Further evaluation and attention should be given to transmission clinical characteristics and the impact of HIV infection in children in West Africa where both HIV-1 and HIV-2 are seen. (authors)

HIV-1 and HIV-2 infection in children in Abidjan, Côte d'Ivoire.

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HIV-1 and HIV-2 infection in children in Abidjan, Côte d'Ivoire.