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February 28, 1996

Neonatal Characteristics in Rapidly Progressive Perinatally Acquired HIV-1 Disease

Marie-Jeanne Mayaux; Marianne Burgard, MD; Jean-Paul Teglas, MS; et al Jacqueline Cottalorda, MD; Anne Krivine, MD; François Simon, MD; Jacqueline Puel, MD; Catherine Tamalet, MD; Dominique Dormont, MD; Bernard Masquelier, MD; Anne Doussin, MD; Christine Rouzioux, PhD; Stéphane Blanche, MD; B. Pautard; D. Brault; J. Mamou; A. Broyart; M. Dandine; X. Hernandorena; P. Balde; E. Lachassine; D. Douard; H. Fleury; B. Masquelier; I. Gilles; A. Gantzer; A-M. Colin-Gorki; J. Brouard; F. Freymuth; L. Keros; P. Labrune; M. Vial; F. Mazy; C. Floch; P. Bourdon; M. Duval-Arnould; C. Huraux-Rendu; S. Lemerle; M. Boddaert; M-F. Denavit; K. Lahsinat; C. Pascal; A. Leblanc; A. May; C. Dallot; D. Dormont; B. Bader-Meunier; E. Dussaix; M. Tardieu; H. Seaume; P. Wipff; P. Deboisse; G. Michel; C. Tamalet; D. Vallée; C. Crumière; A. Saillant; B. Le Lorier; C. Botto; D. Seguy; P. Talon; C. Huret; J. Nicolas; J. Lalande; F. Mechineau-Lacroix; D. Berterottière; J. Cottalorda; A. Deville; F. Monpoux; A. de Crepy; F. Simon; S. Parat; G. Firtion; M. Ronzier; C. Brunner; N. Ciraru-Vigneron; B. Heller-Roussin; S. Blanche; M. Burgard; D. Girault; C. Rouzioux; J. Terris; F. Veber; J-M. Huraux; G. Noseda; M. Levine; E. Vilmer; A. Vallet; L. Marpeau; F. Parnet Mathieu; C. Aufrant; C. Francoual; A. Krivine; F. Hervé; C. Courpotin; C. Dollfus; C. Carlus Moncomble; M-C. Rousset; G. Mouchnino; V. Brossard; C. Buffet-Janvresse; M. Robin; F. Labbe-Filou; M. C. Allemon; J.-M. Retbi; P. Narcy; A.-M. Raison Boulley; J. Puel; J. Tricoire; F. Barin; J.-C. Borderon; R. Busuttil; A. Vinas; F. Guillot; A. Lacroix-Coutry.
Author Affiliations

From the Institut National de la Santé et de la Recherche Médicale, Unit 292, Hôpital Bicêtre, Le Kremlin-Bicêtre, France (Ms Mayaux, Mr Teglas, and Dr Doussin); Laboratory of Virology of Hôpital Necker, Paris, France (Drs Burgard and Rouzioux); Laboratory of Virology of Hôpital Pasteur, Nice, France (Dr Cottalorda); Laboratory of Virology of Hôpital Port Royal, Paris, France (Dr Krivine); Laboratory of Virology of Hôpital Bichat, Paris, France (Dr Simon); Laboratory of Virology of Hôpital Purpan, Toulouse, France (Dr Puel); Laboratory of Virology of Hôpital La Timone, Marseille, France (Dr Tamalet); Commissariat Energie Atomique, Fontenay-aux-Roses, France (Dr Dormont); Laboratory of Virology of Hôpital Pellegrin Tripode, Bordeaux, France (Dr Masquelier); and Institut National de la Santé et de la Recherche Médicale, Unit 429, Hôpital Necker, Paris, France (Dr Blanche).

JAMA. 1996;275(8):606-610. doi:10.1001/jama.1996.03530320030030

Objective.  —To identify clinical and laboratory parameters at birth that are associated with the rapidly progressive form of human immunodeficiency virus type 1 (HIV-1) disease in children born to infected mothers.

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—seropositive 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.  —Category C events (including opportunistic infections, recurrent severe bacterial infections, cancers, specific encephalopathy, and wasting syndrome) in the new pediatric Centers for Disease Control and Prevention 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 when an infected newborn had liver and/or spleen enlargement and/or adenopathies (38.1% vs 15.1%; relative risk [RR], 2.5; 95% confidence interval [CI], 1.4 to 6.0; P<.02) or a low proportion (<30%) of CD4+ cells at birth (45.5% vs 15.0%; RR, 3.0; 95% CI, 1.4 to 6.4; P<.005). Similarly, HIV-1 culture and/or polymerase chain reaction positivity during the first week of life was associated with a higher risk of the early, 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 was 50.0% vs 14.4% (RR, 3.5; 95% CI, 1.9 to 6.2; P<.001 ). These parameters, determined at birth, were strongly interrelated and could reflect active disease onset in utero in some cases of early, severe HIV-1 disease in childhood.

Conclusions.  —These prognostic markers, particularly virological parameters, are of value in monitoring children infected by HIV and might serve as a basis for early therapeutic intervention.(JAMA. 1996;275:606-610)