Pneumocystis carinii pneumonia and cytomegalovirus infection in children with vertically acquired HIV infection

Objectives: The outcome of Pneumocystis carinii pneumonia (PCP) in HIV-infe cted infants is poor, and the role of cytomegalovirus (CMV) co-infection in the course and outcome of PCP is unclear. This study describes the prevale nce, clinical characteristics, management and changes in survival over time of vertically HIV-infected infants developing PCP and/or CMV infection. Methods: Data on children with HIV, born in the UK and ireland and reported to the National Study of HIV in Pregnancy and Childhood, with PCP and/or C MV were combined with clinical information collected from reporting paediat ricians. Results: By April 1998, 340 vertically HIV-infected children had been repor ted, of whom 93 had PCP and/or CMV, as their first AIDS indicator disease; 85 (91%) were infants. Among infants with PCP, 79% were born to mothers not diagnosed as HIV infected, and there was an independent and statistically significant association with breast-feeding, being black African, and devel oping CMV disease. Median survival after PCP and/or CMV was significantly b etter in those born between 1993 and 1998 compared with those born before 1 993 (P = 0.009), and worse than after other AIDS diagnoses (P = 0.01). Infa nts with dual infection were more likely to be ventilated (P = 0.003) and r eceive corticosteroids (P = 0.002) than those with PCP alone. Conclusion: Although survival from PCP and CMV has improved over time, thes e remain serious and potentially fatal infections among infants in whom mat ernal HIV status is not recognized in pregnancy. Breast-feeding increases t he risk of combined PCP and CMV infection, which is associated with severe disease. (C) 2001 Lippincott Williams & Wilkins.