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Children with HIV have increased risk for IPD, varicella zoster hospitalization
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Children with HIV have an increased risk for hospitalization with invasive pneumococcal disease or varicella zoster compared with children who do not have HIV, according to study findings in The Pediatric Infectious Disease Journal.
Helen Payne, MBChB, BSc, MRCPCH, of the Pediatric Infectious Diseases Unit at St. George’s Healthcare NHS Trust in London, and colleagues assessed hospitalizations reported to the Collaborative HIV Paediatric Study, a multi-center observational cohort study of all children with HIV who receive pediatric care in the United Kingdom and Ireland. Hospital admissions with a primary cause of invasive pneumococcal disease (IPD), varicella zoster, or all-cause lower respiratory infections between January 1996 and December 2011 were evaluated. Children were aged 18 years and younger.
During the study period, 3,905 hospital admissions among 1,119 children were recorded. Of these, 23 admissions among 22 children were due to IPD, 107 admissions among 99 children were due to varicella, and 89 admissions among 79 children were due to herpes zoster. This indicates a combined number of 196 admissions among 172 children due to varicella zoster, according to the authors.
IPD admissions were generally low during the study period. The number of varicella zoster admissions declined over time, but proportions did not decline.
There were no differences in sex, route of HIV transmission, birthplace, median age at HIV diagnosis or CD4 percentage or count at HIV diagnosis between children with IPD, varicella zoster, and those without IPD or varicella zoster admissions.
A greater proportion of children admitted with IPD or varicella zoster were diagnosed with HIV at a later clinical stage compared with children who were not admitted (36.8%; 29.7%; and 22.1%, respectively). Children who experienced IPD or varicella zoster were more likely to have started combined ART during study follow-up compared with children who were not admitted.
Approximately 16% of children admitted for IPD had received combined ART for at least 6 months prior to admission, while 84.2% had not received therapy. Approximately 35% of children admitted for varicella zoster received combined ART for at least 6 months prior to admission. Median age at first admission for IPD and varicella zoster was higher among children receiving combined ART than those not receiving combined ART.
Although statistically insignificant, IPD admissions were more common later in the calendar year for all children, regardless of combined ART status.
Admission duration for IPD or varicella zoster hospitalizations did not differ regarding combined ART status. There was no significant difference among median CD4 percentage or count at admission between children who received combined ART and those who did not receive combined ART. However, medial viral load was significantly lower among children who received combined ART who were hospitalized for varicella zoster.
Children treated with combined ART had significantly higher incidence rates and rate ratios for all three infections compared with those not did not receive combined ART. The incidence rate for herpes zoster was 12.2 per 1,000 patient years among children who did not receive combined ART vs. 3.5 per 1,000 patient years among those who did receive combined ART. The incidence rate for all-cause lower respiratory infections was 46.1 cases per 1,000 patient years among children not on therapy vs. 6.4 cases per 1,000 patient years for children on combined ART. These rates were 1.7-fold higher than incidence among all children, aged 0 to 14 years, in England; and 12-fold higher than children with HIV who were not receiving combined ART.
“The study highlights the increased risk of admission with IPD or [varicella zoster] disease in HIV-infected children compared to their uninfected peers, a risk which is increased in children who have not commenced [combined ART]. Earlier initiation of [combined ART] combined with vaccination is probably required to optimize protection against these infections. This study provides evidence to support attempts to improve routine vaccination uptake as well as promoting the recent Paediatric European Network for Treatment of AIDs/Children’s HIV Association guidelines recommending varicella vaccination for children with stable HIV,” the researchers concluded.
Disclosure: The researchers report no relevant financial disclosures.
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