NEONATAL CHARACTERISTICS IN RAPIDLY PROGRESSIVE PERINATALLY ACQUIRED HIV-1 DISEASE

Objective. - To identify clinical and laboratory parameters at birth t hat are associated with the rapidly progressive form of human immunode ficiency virus type 1 (HIV-1) disease in children born to infected mot hers. Design. - Multicenter, prospective study of infants born to HIV- seropositive mothers. Setting. - A total of 62 obstetric and pediatric centers in France. Participants. - Of 1386 children born to HIV-1-ser opositive mothers at least 18 months before the cutoff date, 267 were infected. Infection was defined as serological positivity at 18 months or death from HIV disease before this age. Main Outcome Measure. - Ca tegory C events (including opportunistic infections, recurrent severe bacterial infections, cancers, specific encephalopathy, and wasting sy ndrome) in the new pediatric Centers for Disease Control and Preventio n classification during the first year of life, according to clinical, immunological, and virological findings at birth. Results. - The risk of category C manifestations at 12 months was significantly higher wh en an infected newborn had liver and/or spleen enlargement and/or aden opathies (38.1% vs 15.1%; relative risk [RR], 2.5; 95% confidence inte rval [CI], 1.4 to 6.0; P<.02) or a low proportion (<30%) of CD4(+) cel ls at birth (45.5% vs 15.0%; RR, 3.0; 95% CI, 1.4 to 6.4; P<.005). Sim ilarly, HIV-1 culture and/or polymerase chain reaction positivity duri ng the first week of life was associated with a higher risk of the ear ly, severe form of HIV infection (26.4% vs 9.3%; RR, 2.8; 95% CI, 1.3 to 6.1; P<.006). In case of positive antigenemia at birth, the risk wa s 50.0% vs 14.4% (RR, 3.5; 95% CI, 1.9 to 6.2; P<.001). These paramete rs, determined at birth, were strongly interrelated and could reflect active disease onset in utero in some cases of early, severe HIV-1 dis ease in childhood. Conclusions. - These prognostic markers, particular ly virological parameters, are of value in monitoring children infecte d by HIV and might serve as a basis for early therapeutic intervention .