Respiratory diseases in the first year of life in children born to HIV-1-infected women

Our objective was to describe the respiratory complications, clinical findi ngs, and chest radiographic changes in the first year of life in infected a nd uninfected children born to HIV-1-infected women. We prospectively follo wed a cohort of 600 infants born to HIV-l-infected women from birth to 12 m onths in a multicenter study. Of these, 93 infants (15.5%) were HIV-1 infec ted, 463 were uninfected, and 44 were of unknown status prior to death or l oss to follow-up. The cumulative incidence (+/- SE) of an initial pneumonia episode at 12 mon ths was 24.1 +/- 4.7% in HIV-1-infected children compared to 1.4 +/- 0.6% i n HIV-1-uninfected children (P < 0.001). The rate of Pneumocystis carinii p neumonia (PCP) was 9.5 per 100 child-years. The HIV-1 RNA load was not high er in the group that developed pneumonia in the first year vs. those who di d not. Children who developed lower respiratory tract infections or PCP had increased rates of decline of CD4 cell counts during the first 6 months of life. Lower maternal CD4 cell counts were associated with higher rates of pneumonia, and upper and lower respiratory tract infections, The rates of u pper respiratory tract infection and bronchiolitis/reactive airway disease in infected children were not significantly different than in uninfected ch ildren. At 12 months, significantly more HIV-1-infected than uninfected chi ldren had tachypnea and chest radiographs with nodular and reticular densit ies. There was no relationship between cytomegalo virus infection in the fi rst year of life and radiographic changes or occurrences of pneumonia. In conclusion, despite a low incidence of PCP, rates of pneumonia remain hi gh in HIV-infected children in the first year of life. The incidence of pne umonia in uninfected infants born to HIV-1-infected mothers is low. Chest X -ray abnormalities and tachypnea suggest that subacute disease is present i n infected infants. Further follow-up is warranted to determine its nature. <(c)> 2001 Wiley-Liss. Inc.