Immunologic and Virologic Factors Associated with Hospitalization in HIV-Exposed, Uninfected Infants in the United States

2021 ◽  
Author(s):  
Christiana Smith ◽  
Yanling Huo ◽  
Kunjal Patel ◽  
Kirk Fetters ◽  
Shannon Hegemann ◽  
...  
Keyword(s):  
United States ◽  
Regression Models ◽  
The United States ◽  
Pediatric Hiv ◽  
First Year ◽  
Virus Family ◽  
Vaccine Antigens ◽  
Hiv Exposed ◽  
First Year Of Life ◽  
Exposed Uninfected

Abstract Background HIV-exposed, uninfected (HEU) infants experience higher rates of morbidity and mortality than HIV-unexposed uninfected (HUU) infants. Few studies have examined whether particular infections and/or immune responses are associated with hospitalization among HEU infants born in the United States. Methods We evaluated a subset of HEU infants enrolled in the International Maternal Pediatric Adolescent AIDS Clinical Trials Group P1025 and/or Pediatric HIV/AIDS Cohort Study Surveillance Monitoring for ART Toxicities studies. We determined seroconversion to 6 respiratory viruses and measured antibody concentrations to 9 vaccine antigens using quantitative ELISA or electrochemiluminesence. Multivariable modified Poisson regression models were fit to evaluate the associations of seroconversion to each respiratory virus/family and antibody concentrations to vaccine antigens with the risk of hospitalization in the first year of life. Antibody concentrations to vaccine antigens were compared between HEU infants and HUU infants from a single site using multivariable linear regression models. Results Among 556 HEU infants, seroconversion to respiratory syncytial virus (RSV) and parainfluenza were associated with hospitalization [adjusted risk ratio: 1.95 (95% CI 1.21-3.15); 2.30 (1.42-3.73), respectively]. Antibody concentrations to tetanus toxoid, pertussis, and pneumococcal vaccine antigens were higher among 525 HEU compared with 100 HUU infants. No associations were observed between antibody concentrations to any vaccine and hospitalization among HEU infants. Conclusions RSV and parainfluenza contribute to hospitalization among HEU infants in the first year of life. HEU infants demonstrate robust antibody responses to vaccine antigens; therefore, humoral immune defects likely do not explain the increased susceptibility to infection observed in this population.

scholarly journals 2571. Higher Rates of Hospitalization and Infection-Related Hospitalization Among HIV-Exposed Uninfected Infants Compared with HIV Unexposed Uninfected Infants in the United States

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S74-S75
Author(s):  
Sarah M Labuda ◽  
Yanling Huo ◽  
Deborah Kacanek ◽  
Kunjal Patel ◽  
Jennifer Jao ◽  
...  
Keyword(s):  
United States ◽  
Poisson Regression ◽  
The United States ◽  
Pediatric Hiv ◽  
Hiv Disease ◽  
Significant Difference ◽  
Maternal Hiv ◽  
Hiv Exposed ◽  
Stock Dividends ◽  
Exposed Uninfected

Abstract Background Studies from multiple countries have suggested impaired immunity in perinatally HIV-exposed uninfected (HEU) children, with elevated rates of all-cause hospitalization and infections. We estimated the incidence of all-cause hospitalization and infection-related hospitalization in the first 2 years of life among HEU children and compared this with HIV-unexposed uninfected (HUU) children in the US Among HEU children, we evaluated associations of maternal HIV disease-related factors during pregnancy with risk of infant hospitalization. Methods We evaluated HEU children enrolled in the Surveillance Monitoring for ART Toxicities (SMARTT) Study dynamic cohort of the Pediatric HIV/AIDS Cohort Study (PHACS) network who were born 2006–2017 and followed from birth. Data on HUU children were obtained from the Medicaid Analytic Extract database, restricted to states participating in SMARTT. We compared rates of first hospitalization, total hospitalizations, first infection-related hospitalization, total infection-related hospitalizations, and mortality between HEU and HUU children using Poisson regression. Among HEU children, multivariable Poisson regression models were fit to evaluate associations of maternal HIV factors with risk of hospitalization. Results Our analysis included 2,404 HEU and 3,605,864 HUU children. HEU children had approximately 2 times greater rates of first hospitalization, total hospitalizations, first infection-related hospitalization, and total infection-related hospitalizations compared with HUU children (figure). There was no significant difference in mortality. Among HEU children, maternal HIV disease factors, including viral load, CD4 count, antiretroviral regimen, and mode of HIV acquisition, were not associated with hospitalization rates. Conclusion Compared with HUU, HEU children in the United States have nearly twice the rate of hospitalization and infection-related hospitalization in the first 2 years of life, consistent with studies in other countries. Closer monitoring of HEU infants for infection and further elucidation of immune mechanisms is needed. Disclosures E. G. Chadwick, Abbott Labs: Shareholder, stock dividends. AbbVie: Shareholder, stock dividends. R. Van Dyke, Giliad Sciences: Grant Investigator, Research grant.

COMPLICATIONS OF SMALLPOX VACCINATION UNITED STATES 1963

PEDIATRICS ◽  
1967 ◽  
Vol 39 (6) ◽  
pp. 916-923
Author(s):  
John M. Neff ◽  
Ronald H. Levine ◽  
J. Michael Lane ◽  
Ernest A. Ager ◽  
Helen Moore ◽  
...  
Keyword(s):  
United States ◽  
High Frequency ◽  
Primary Vaccination ◽  
The United States ◽  
Smallpox Vaccination ◽  
First Year ◽  
Common Complication ◽  
More Care ◽  
First Year Of Life

Four thousand nine hundred physicians in four states, representing 4.8% of the population of the United States, were surveyed in order to assess the frequency and types of complications that occurred during 1963 in association with smallpox vaccination. Four hundred ninety-one physicians initially reported observing 810 complications during this year. On follow-up of these cases, many were not actually complications or were complications that occurred in a year other than 1963. Accidental infection was the most common complication. Generalized vaccinia and eczema vaccinatum occurred at a frequency of 238 and 80, respectively, per million primary vaccinations. Severe complications were infrequent. No deaths and only one case each of post-vaccinal encephalitis and vaccinia necrosum were detected. The high frequency of many preventable complications and the disproportionate frequency of complications in infants suggest that morbidity and mortality now associated with smallpox vaccination could be significantly reduced if primary vaccination could be deferred until after the first year of life and if more care were taken to detect individuals in whom complications can be expected to occur.

scholarly journals 114. Birth Prevalence of Congenital Cytomegalovirus Infection and Language, Hearing, and Developmental Outcomes in a Cohort of HIV-Exposed, Uninfected Preschool Children

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S3-S3
Author(s):  
Murli Purswani ◽  
Tzy-Jyun Yao ◽  
Jonathan S Russell ◽  
Kathleen Malee ◽  
Stephen A Spector ◽  
...  
Keyword(s):  
United States ◽  
Cytomegalovirus Infection ◽  
Developmental Outcomes ◽  
The United States ◽  
Hiv Viral Load ◽  
Congenital Cytomegalovirus Infection ◽  
Congenital Cytomegalovirus ◽  
Birth Prevalence ◽  
Hiv Exposed ◽  
Exposed Uninfected

Abstract Background The prevalence of congenital cytomegalovirus infection (cCMV) at birth is 0.5%–1% in the United States. Most cCMV newborns are asymptomatic at birth with 10%–15% subsequently developing sequelae, such as hearing loss. Higher cCMV prevalence (2.5%–11.4%) is reported in infants born to HIV-infected women, associated with maternal immune suppression and lack of antiretroviral therapy (ART), with few studies addressing neurodevelopmental (ND) outcomes in their offspring. We report birth prevalence of cCMV in a cohort of HIV-exposed, uninfected infants (HEU) born to women on combination ART with well-controlled HIV and describe ND outcomes through age 5 years. Methods The Surveillance Monitoring for ART Toxicities (SMARTT) study is an ongoing NICHD-funded observational multi-centered cohort study (United States and Puerto Rico) of growth and development of HEU children that commenced in 2007. As of August 1, 2017, participants with stored blood pellets collected ≤3 weeks after birth and at least 1 ND assessment ≥1 year of age had pellets tested by DNA PCR to establish cCMV. Comparisons of ND outcomes (defined in figure) at ages 1, 2, and 5 by cCMV status were made using Wilcoxon and Fisher’s Exact tests. Results Of 895 children meeting study criteria (55% black; 32% white; 40% Latino), 8 had cCMV, yielding a birth prevalence of 0.89% (95% CI 0.39–1.75%). All were asymptomatic and similar to CMV-uninfected infants in gestational age and anthropometric measurements at birth. The last HIV viral load prior to delivery was undetectable in 88% of women. The last available CD4% was <20% in 3/8 mothers of cCMV newborns compared with 112/873 in those without (38% vs. 13%, P < 0.07). The mean duration of follow-up (± standard deviation) of children with cCMV was 7.2 years (1.6) and those without 5.9 (2.3) years (P < 0.11). ND assessments for language development (CDI at 1, A&S at 2, TOLD-P:3 at 5), cognition (Bayleys-III at 1), intelligence (WPPSI-III at 5), and hearing (PTA at 5) did not differ by cCMV status (figure). Conclusion Birth prevalence of cCMV in HEU children born within the last decade approaches national US prevalence. Preschool HEU children with asymptomatic cCMV at birth did not show poorer language, hearing, and developmental outcomes compared with CMV-uninfected HEU children. Disclosures All authors: No reported disclosures.

scholarly journals Third Trimester Vitamin D Status Is Associated With Birth Outcomes and Linear Growth of HIV-Exposed Uninfected Infants in the United States

2019 ◽  
Vol 81 (3) ◽  
pp. 336-344 ◽  
Author(s):  
Christopher R. Sudfeld ◽  
Denise L. Jacobson ◽  
Noé M. Rueda ◽  
Daniela Neri ◽  
Armando J. Mendez ◽  
...  
Keyword(s):  
United States ◽  
Vitamin D ◽  
Birth Outcomes ◽  
Linear Growth ◽  
The United States ◽  
Vitamin D Status ◽  
Third Trimester ◽  
Hiv Exposed ◽  
Exposed Uninfected

The Effect of Birth Month on the Risk of Respiratory Syncytial Virus Hospitalization in the First Year of Life in the United States

2014 ◽  
Vol 33 (6) ◽  
pp. e135-e140 ◽  
Author(s):  
Patricia Calderón Lloyd ◽  
Larissa May ◽  
Daniel Hoffman ◽  
Richard Riegelman ◽  
Lone Simonsen
Keyword(s):  
United States ◽  
Respiratory Syncytial Virus ◽  
The United States ◽  
First Year ◽  
Birth Month ◽  
Syncytial Virus ◽  
First Year Of Life

INFANT MORTALITY RATES FOR THE TOWN OF SALEM, MASSACHUSETTS, IN 1782 AND 1783

PEDIATRICS ◽  
1966 ◽  
Vol 38 (5) ◽  
pp. 800-800
Author(s):  
T. E. C.
Keyword(s):  
United States ◽  
Mortality Rate ◽  
Infant Mortality ◽  
New England ◽  
The United States ◽  
Infant Mortality Rate ◽  
First Year ◽  
True Index ◽  
First Year Of Life ◽  
The Town

The infant mortality rate for a single New England town for the years 1782 and 1783 cannot be used as a true index of this statistic for the 13 states which made up the United States during the 1780's. As we lack data concerning infant mortality for the country as a whole during this period, information about the mortality of infants in the town of Salem, Massachusetts, where all births were recorded, should be of interest to pediatricians. Doctor Edward A. Holyoke of Salem in a letter to Mr. Caleb Garnett, the Recording Secretary of the American Academy of Arts and Sciences, gave these figures for the town of Salem: In 1782 there were 311 live-born infants and of these 36 died before they reached their first birthday, for an infant mortality rate of 115. In 1783 of 374 live-born infants, 38 died during their first year of life, for an infant mortality of 102. When one recalls that the rate for 1915 in the United States was 100, the infants, at least in Salem, did not fare too badly.

scholarly journals Rates of Hospitalization and Infection-Related Hospitalization Among Human Immunodeficiency Virus (HIV)–Exposed Uninfected Children Compared to HIV-Unexposed Uninfected Children in the United States, 2007–2016

2019 ◽  
Vol 71 (2) ◽  
pp. 332-339
Author(s):  
Sarah M Labuda ◽  
Yanling Huo ◽  
Deborah Kacanek ◽  
Kunjal Patel ◽  
Krista Huybrechts ◽  
...  
Keyword(s):  
United States ◽  
Human Immunodeficiency Virus ◽  
Poisson Regression ◽  
The United States ◽  
Hiv Disease ◽  
Significant Difference ◽  
Immunodeficiency Virus ◽  
Maternal Hiv ◽  
Hiv Exposed ◽  
Exposed Uninfected

Abstract Background Studies from multiple countries have suggested impaired immunity in perinatally human immunodeficiency virus (HIV)–exposed uninfected children (HEU), with elevated rates of all-cause hospitalization and infections. We estimated and compared the incidence of all-cause hospitalization and infection-related hospitalization in the first 2 years of life among HEU and HIV-unexposed uninfected children (HUU) in the United States. Among HEU, we evaluated associations of maternal HIV disease–related factors during pregnancy with risk of child hospitalization. Methods HEU data from subjects enrolled in the Surveillance Monitoring for Antiretroviral Therapy Toxicities Study (SMARTT) cohort who were born during 2006–2017 were analyzed. HUU comparison data were obtained from the Medicaid Analytic Extract database, restricted to states participating in SMARTT. We compared rates of first hospitalization, total hospitalizations, first infection-related hospitalization, total infection-related hospitalizations, and mortality between HEU and HUU using Poisson regression. Among HEU, multivariable Poisson regression models were fitted to evaluate associations of maternal HIV factors with risk of hospitalization. Results A total of 2404 HEU and 3 605 864 HUU were included in the analysis. HEU children had approximately 2 times greater rates of first hospitalization, total hospitalizations, first infection-related hospitalization, and total infection-related hospitalizations compared with HUUs. There was no significant difference in mortality. Maternal HIV disease factors were not associated with the risk of child infection or hospitalization. Conclusions Compared with HUU, HEU children in the United States have higher rates of hospitalization and infection-related hospitalization in the first 2 years of life, consistent with studies in other countries. Closer monitoring of HEU infants for infection and further elucidation of immune mechanisms is needed.

Immune Activation and Microbial Translocation Markers in HIV-Exposed Uninfected Malawian Infants in the First Year of Life

2019 ◽  
Vol 65 (6) ◽  
pp. 617-625 ◽  
Author(s):  
Silvia Baroncelli ◽  
Clementina Maria Galluzzo ◽  
Giuseppe Liotta ◽  
Mauro Andreotti ◽  
Sandro Mancinelli ◽  
...  
Keyword(s):  
Immune Activation ◽  
Binding Protein ◽  
Microbial Translocation ◽  
First Year ◽  
Gastrointestinal Infections ◽  
Fatty Acid Binding ◽  
Hiv Exposed ◽  
First Year Of Life ◽  
The Impact ◽  
Exposed Uninfected

Abstract Background HIV-exposed uninfected (HEU) infants show a high rate of morbidity. We aimed to investigate on biomarkers of immune activation/microbial translocation in HEU infants, evaluating the impact that infections/malnutrition can have on biomarker levels during the first year of life. Methods Clinical data of 72 Malawian infants were recorded monthly and correlated with levels of soluble CD14 (sCD14), lipopolysaccharide-binding protein (LBP) and intestinal fatty acid-binding protein (I-FABP), analyzed longitudinally. Results Levels of sCD14 and LBP showed a significant age-related increase. Higher levels of LBP (19.4 vs. 15.2 μg/ml) were associated with stunting, affecting 30% of the infants. The association remained statistically significant after adjusting for cytomegalovirus acquisition, malaria and respiratory infections (p = 0.031). I-FABP levels were significantly increased in infants experiencing gastrointestinal infections (1442.8 vs. 860.0 pg/ml, p = 0.018). Conclusion We provide evidence that stunting is associated with an enhanced inflammatory response to microbial products in HEU children, suggesting that malnutrition status should be taken into consideration to better understand the alteration of the immune profile of HEU infants living in poor socioeconomic settings.

scholarly journals Acylcarnitine Profiles in HIV-Exposed, Uninfected Neonates in the United States

2016 ◽  
Vol 32 (4) ◽  
pp. 339-348 ◽  
Author(s):  
Brian Kirmse ◽  
Tzy-Jyun Yao ◽  
Sean Hofherr ◽  
Deborah Kacanek ◽  
Paige L. Williams ◽  
...  
Keyword(s):  
United States ◽  
The United States ◽  
Hiv Exposed ◽  
Exposed Uninfected
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