Severe, rapidly progressive human immunodeficiency virus type 1 disease innewborns with coinfections

Aim. To describe a severe form of rapidly progressive HIV-1 infection manif esting in the neonatal period. Method. Prospective cohort study, King Edward VIII Hospital, Durban, South Africa. HIV-1-exposed neonates with hepatosplenomegaly, lymphadenopathy or persistent pneumonia within the first 28 days of life were investigated for perinatal infections. Confirmation of neonatal HIV-1 infection, HIV-1 subt ype and clinical outcomes were studied. Results. Twenty-three (72%) of 32 symptomatic HIV-1-exposed neonates recrui ted at a mean of 15.2 days were HIV-1-infected, HIV-1 infection was detecte d in 5 patients who were tested within 48 h of birth, confirming congenital infection, Congenital infection was not excluded in any case. Median neona tal viral load at recruitment was 471 932 copies/ml and median CD4 was 777 cells/mm(3). The predominant clinical presentation was growth retardation a nd prematurity. Perinatal infections detected included: tuberculosis (8), s yphilis (6) and cytomegalovirus (10). All of the neonates with perinatal tu berculosis were HIV-1 coinfected. Maternal and neonatal viral load and CD4 at recruitment were not statistically different between the groups with tub erculosis vs. other coinfections. Gag gene sequence analysis confirmed clos ely aligned HIV-1 subtype C in mothers and neonates. Nineteen (83%) died by 9 months, with a mean age at death of 3.5 months. Conclusions. A distinct group of HIV-1-infected babies may clinically manif est in the neonatal period with perinatal coinfections, subsequent rapidly progressive HIV-1 and early death.