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Session 134
Poster Abstracts Complications in Pediatric HIV Infection Thursday, 1:30 - 3:30 pm Hall B |
Background: HIV-infected
children are at high risk for bacteremia,
particularly with encapsulated bacteria. Since 1996, HAART has reduced rates of
opportunistic infections; less is known about its effect on bacteremia.
We determined the effect of HAART on the incidence of bacteremia
in HIV-infected children in the pre- and post HAART eras.
Methods:
The Perinatal
AIDS Collaborative Transmission Study (PACTS) is a CDC-sponsored multi-center,
prospective cohort study of HIV-exposed infants, enrolled during 1986 to 1999
to monitor mother-to-child transmission and natural history of pediatric HIV
disease. HIV-infected children were followed through April 2004. In this
analysis, all pathogens were included, except Bacillus species, in patients without indwelling catheters and all
non-aureus Staphylococci
and viridans Streptococci.
The incidence of bacteremia was calculated (per 100 patient-years)
for the pre- and post-HAART eras, i.e. before and after January 1, 1997,
respectively. Time to occurrence of first bacteremia
among patients born in the pre- and post-HAART eras was analyzed using survival
analysis.
Results: Among 364 HIV-infected children, 68 had 118 bacteremia, 97 before January 1, 1997
and 21 after January 1, 1097. S. pneumoniae constituted the majority of cases in the
pre- and post-HAART eras, 56 (58%) and 13 (62%) cases, respectively. Kaplan-Meier
analysis for time to first bacteremia in children
born during the pre-HAART compared to post-HAART eras revealed that 69% and 94% remained without bacteremia
at a median follow-up of 6 years (p =
0.02, log rank test). The Cox proportional hazards model also showed a
significant reduction of bacteremia in the post-HAART
era, even after controlling for gender and race (HR = 0.2: 95% CI 0.05 to 0.87).
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Pre-HAART |
Post-HAART |
Rate ratio
(95% CI) |
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Age at
diagnosis n = 364 |
Events (n) |
Incidence
rate per 100
person-years (95% CI) |
Events (n) |
Incidence
rate per 100
person-years (95% CI) |
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0–1 years |
50 |
9.6 (7.2–12.7) |
2 |
1.8 (0.2–6.6) |
0.2 (0.05–0.8) |
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2–3 years |
33 |
10.2 (7–14) |
4 |
2.3 (0.6–5.9) |
0.2 (0.1–0.6) |
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4–6 years |
14 |
9.2 (4.9–15.3) |
10 |
3.8 (1.8–7.1) |
0.4 (0.2–0.9) |
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Cumulative |
97 |
9.8 (7.9–11.9) |
16 |
2.9 (1.7–4.8) |
0.3 (0.2–0.5) |
Conclusions: A significant decrease in the cumulative incidence of bacteremias and a prolongation in the time to first bacteremia were seen in the post-HAART era among this
Keywords: Bacteremia ; Pediatrics; Innocents
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