OBJECTIVE: To investigate the outcome in children perinatally infected with HIV-1 whose mothers received zidovudine (ZDV) monotherapy in pregnancy. DESIGN: Observational retrospective study of a prospectively recruited cohort. SETTING: Italian Register for HIV Infection in Children. PATIENTS: A group of 216 children perinatally infected with HIV-1, born in 1992-1997 and derived prospectively from birth: 38 children had mothers receiving ZDV monotherapy and for 178 children the mothers received no antiretroviral treatment during pregnancy. MAIN OUTCOME MEASURES: The estimated probability of developing severe disease or severe immune suppression, survival probability [95% confidence interval (CI)] within 3 years, and the hazard ratio (95% CI), adjusted for year of birth, maternal clinical condition at delivery, birthweight and treatments (Pneumocystis carinii pneumonia chemoprophylaxis and/or antiretroviral therapy before the onset of severe disease, severe immune suppression or death) were compared. RESULTS: Comparison of HIV-1-infected children whose mothers were treated with ZDV with children whose mothers were not treated showed that the former group had a higher probability of developing severe disease [57.3% (95% CI 40.9-74.3) versus 37.2% (95% CI 30.0-45.4); log-rank test 7.83, P = 0.005; adjusted hazard ratio 1.8 (95% CI 1.1-3.1)] or severe immune suppression [53.9% (95% CI 36.3-73.5) versus 37.5% (95% CI 30.0-46.2); log-rank test 5.58, P = 0.018; adjusted hazard ratio 2.4, (95% CI: 1.3-4.3)] and a lower survival [72.2% (95% CI 50.4-85.7) versus 81.0% (95% CI 73.7-86.5); log-rank test 4.23, P = 0.039; adjusted hazard ratio of death 1.9 (95% CI 1.1-3.6)]. CONCLUSIONS: This epidemiological observation could stimulate virologic studies to elucidate whether this rapid progression depends on in utero infection or transmission of resistant virus. Findings may suggest a need to hasten HIV-1 diagnosis in infants of ZDV-treated mothers and undertake an aggressive antiretroviral therapy in those found to be infected
Rapid disease progression in HIV-1 perinatally infected children born to mothers receiving zidovudine monotherapy during pregnancy. The Italian register for HIV Infection in Children / de Martino, M; Galli, L; Tovo, P. A.; Gabiano, C; Osimani, P; Zizzadoro, P; de Mattia, D; Ruggeri, M; Lanari, M; Dalla Vecchia, S; Masi, M; Miniaci, A; Baldi, F; Dell' Erba, G; Battisti, L; Duse, M; Crispino, P; Uberti, E; Bresciani, E; Chiriacò, P. G.; Pintor, C; Dedoni, M; Loriano, D; Dessì, C; Anastasio, L; Sabatino, G; Sticca, M; Berrino, R; Lodato, A; Vierucci, A; Farina, S; de Luca, M; de Maria, A; Fioredda, F; Boni, S; Marazzi, M. G.; Pontali, E; Forni, Gl; Gotta, C; Tasso, L; Gambaretto, G; Meo, A; Plebani, R; Pinzani, R; Salvini, F; Marchisio, P; Massironi, E; Tornaghi, R; Zuccotti, Gv; Riva, S; de Carlis, S; Ferraris, G; Bucceri, A; Lipreri, R; Cellini, M; Guarino, Alfredo; Pignata, Claudio; Tarallo, L; Giaquinto, C; Ruga, E; Rampon, O; Romano, A; Benaglia, G; Caselli, D; Maccabruni, A; Consolini, R; Palla, G; Antonellini, A; Magnani, C; Cecchi, T; Castelli Gattinara, G; Bernardi, S; Cancrini, C; Fundarò, C; Genovese, O; Rendeli, C; Timpano, C; Anzidei, G; Catania, S; Stegagno, M; Mazza, A; Salvatore, C; Scolfaro, C; Palomba, E; Riva, C; Pellegatta, A.. - In: AIDS. - ISSN 1473-5571. - 28:13(1999), pp. 927-933.
Rapid disease progression in HIV-1 perinatally infected children born to mothers receiving zidovudine monotherapy during pregnancy. The Italian register for HIV Infection in Children.
GUARINO, ALFREDO;PIGNATA, CLAUDIO;
1999
Abstract
OBJECTIVE: To investigate the outcome in children perinatally infected with HIV-1 whose mothers received zidovudine (ZDV) monotherapy in pregnancy. DESIGN: Observational retrospective study of a prospectively recruited cohort. SETTING: Italian Register for HIV Infection in Children. PATIENTS: A group of 216 children perinatally infected with HIV-1, born in 1992-1997 and derived prospectively from birth: 38 children had mothers receiving ZDV monotherapy and for 178 children the mothers received no antiretroviral treatment during pregnancy. MAIN OUTCOME MEASURES: The estimated probability of developing severe disease or severe immune suppression, survival probability [95% confidence interval (CI)] within 3 years, and the hazard ratio (95% CI), adjusted for year of birth, maternal clinical condition at delivery, birthweight and treatments (Pneumocystis carinii pneumonia chemoprophylaxis and/or antiretroviral therapy before the onset of severe disease, severe immune suppression or death) were compared. RESULTS: Comparison of HIV-1-infected children whose mothers were treated with ZDV with children whose mothers were not treated showed that the former group had a higher probability of developing severe disease [57.3% (95% CI 40.9-74.3) versus 37.2% (95% CI 30.0-45.4); log-rank test 7.83, P = 0.005; adjusted hazard ratio 1.8 (95% CI 1.1-3.1)] or severe immune suppression [53.9% (95% CI 36.3-73.5) versus 37.5% (95% CI 30.0-46.2); log-rank test 5.58, P = 0.018; adjusted hazard ratio 2.4, (95% CI: 1.3-4.3)] and a lower survival [72.2% (95% CI 50.4-85.7) versus 81.0% (95% CI 73.7-86.5); log-rank test 4.23, P = 0.039; adjusted hazard ratio of death 1.9 (95% CI 1.1-3.6)]. CONCLUSIONS: This epidemiological observation could stimulate virologic studies to elucidate whether this rapid progression depends on in utero infection or transmission of resistant virus. Findings may suggest a need to hasten HIV-1 diagnosis in infants of ZDV-treated mothers and undertake an aggressive antiretroviral therapy in those found to be infectedI documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
