IMMUNOLOGICAL CHARACTERIZATIONS IN CHILDR EN WITH BACTERIAL-INFECTIONS

Background Bacterial infections are a major cause of illness in HIV-in fected children. HIV-infected children with severe dysfunction of cell ular and humoral immunity are particulary vulnerable. Methods and pati ents We conducted a retrospective study to analyse the incidence and s pectrum of bacterial infections in HIV-infected children compared to H IV-exposed but not infected controls related to their immunological st atus. Data collected during 1985 to May 1993 were evaluated considerin g 333 HIV-infected and 81 controls. Results During observation time 35 9 episodes (29% of the visits) of purulent rhinitis were diagnosed in HIV-infected children compared to the controls (53 episodes/8%); p = 0 .0001. Comparable results were seen in otitis media. 178 episodes/14% were found in HIV-infected children and 66 episodes/10% in the control s (p = 0.001). 53 episodes/5% of bacterial pneumonia were represented in HIV-infected versus 11 episodes/2% in controls (p = 0.001). The inc rease of lymphocyte immune defect correlated to an increase of bacteri al infections. This alterations were particulary observed in HIV-infec ted children with bacterial pneumonia. Severe dysfunction of cellular immunity was found in children with recurrent pneumonia compared to ch ildren with only one episode of bacterial pneumonia. The proliferate r esponse of peripheral blood lymphocyte to pokeweed mitogen (13351 cpm versus 3080 cpm); p = 0.009 and Concanavalin A (12607 cpm versus 2470 cpm); p = 0.01 was significantly reduced in both groups, although the defect was much more pronounced in the group with the recurrent pneumo nia. Conclusions Our observations results showed that bacterial respir atory tract infections occured significantly more frequently in HIV-in fected children compared to an age related control group. Not only the occurence of opportunity infections but also severe bacterial infecti ons especially recurrent pneumonia are associated with a defect in cel l-mediated immunity.