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.
|Autori:||Author(s): de Martino; M; Galli; L; Tovo; PA; Gabiano; C; Zappa; M; Group Author(s): Italian Register HIV Infect Children Italian Register: Osimani; P; Zizzadoro; P; De Mattia; D; Ruggeri; M; Lanari; M; Dalla Vecchia; S; Masi; M; Baldi; F; Battisti; L; duse; M; Crispino; P; Uberti; E; Bresciani; E; Chiriacò; PG; pintor; C; Dedoni; M; Loriano; D; Dessi; 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; MG; Pontali; E; Forni; GI; Gotta; C; Tasso; L; Gambaretto; G; Meo; A; Plebani; A; Pinzani; R; Salvini; F; Marchisio; P; Massironi; E; Tornaghi; R; Zuccotti; GV; Riva; S; De Carlis; S; Ferraris; G; Bucceri; A; Liprieri; R; Cellini; M; Guarino; A; Pignata; C; Tarallo; L; Giaquinto; C; Ruga; E; Rampon; O; Romano; A; Benaglia; G; Caselli; D; Maccabruni; A; Consolini R; et al|
|Titolo:||Rapid disease progression in HIV-1 perinatally infected children born to mothers receiving zidovudine monotherapy during pregnancy|
|Anno del prodotto:||1999|
|Appare nelle tipologie:||1.1 Articolo in rivista|