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Clin Infect Dis. 2014 Nov 1;59(9):1332-45. doi: 10.1093/cid/ciu586. Epub 2014 Jul 22.

Increased risk of serious bacterial infections due to maternal immunosuppression in HIV-exposed uninfected infants in a European country.

Collaborators (243)

Mandelbrot L, Crenn-Hebert C, Floch-Tudal C, Mazy F, Joras M, Meier F, Mortier E, Ceccaldi PF, Banige M, Uludag AV, Zarouk V, Lefort A, Hittinger G, Chamouilli JM, Burle C, Lafeuillade A, Medus M, Bachelard G, Dendale J, Guimard T, Guimard K, Brossier JP, Perre P, Esnault JL, Stragier OB, Leautez-Nainville S, Martha SA, Martha B, Maurel E, Francoise M, Barat M, Murger P, Rouha M, Lumbroso P, Checoury A, Perfezou P, Blondin G, Ansart S, Daniel C, Calvez C, Boutard E, Arvieux C, Bauville E, Dupre C, Poinsignon Y, Grelier A, Mousset G, Cudeville C, Niault M, Belzic I, Moreau P, Le Coz MF, Vaillant OL, Tardif VV, Gaillat J, Vanderbergh A, Braig S, Dehlinger-Paul M, Mohamed K, Heller-Roussin B, Winter C, Firtion G, Pannier E, Costa M, Launay O, Ceron DS, Matheron S, Rajguru M, Elaoun N, Allal L, Azria E, Bourgeois A, Garrait V, Hau I, Touboul C, Ratsimbazafy L, Komme C, Elharrar B, Labaune JM, Cotte L, Rudigoz RC, Elleau C, Runel C, Pistone T, Muanza B, Broustal E, Duval-Arnould M, Carpentier B, Dienga E, Partisani ML, Entz-Werle N, David E, Rey D, Seaume H, Ducrocq S, Bailly-Salin P, Tricoire J, Berrebi A, Cayla C, Chace A, Metheron I, Boutemy A, Armangaud D, Couderc S, Routier C, Alissa A, Questiaux E, Zakaria A, Dauphin H, Goissen C, Belloy M, Delassus JL, Partisani M, Cheneau C, Lang JM, Brault D, Allisy C, Lebrette MG, Selleret L, Herve F, Bolot P, Khuong-Josses MA, Ekoukou D, Bounan S, Blanche S, Lemercier D, Frange P, Veber F, Fisher A, Granier M, Devidas A, Nguyen R, May A, Chabrol A, Chevojon P, Moussa ZA, Pluchart C, Rouger C, Tubiana R, Bonmarchand M, Shneider L, Caby F, Calin RO, Coursol A, Chambrin V, Labrune P, Clech L, Pauly-Ravelly I, Moalim R, Sanchez L, Johnson A, Lachassine E, Benoist L, Jeantils V, Gaudelus J, Benbara A, Borgne A, Karaoui L, Lefevre V, Bongain A, Monpoux F, Deville A, Galiba E, Doumet A, Schmidt JL, Cravello L, Hubert C, Dollfus C, Herve F, Tabone MD, Courcoux MF, Leverger G, Carbonne B, Pinquier D, Clavier B, Pinto-Cardoso G, Faye A, Matheron S, Levine M, Marouts EB, Borie C, Boissinot C, Peretti D, Fourcade C, Chirouze C, Hafner C, Reliquet V, Brunet-Cartier C, Winer N, Vaucel E, Briandet C, Brouard J, Demersay AC, Hentgen V, Messaoudi F, Maakroun Z, Nau P, Kebaili K, Billiemaz K, Abrudan R, Fialaire P, Proust S, Arsac P, Mesnard L, Werner E, Ciraru-Vigneron N, Mouchnino G, Ayral D, Vintejoux E, Lalande M, Reynes J, Segondy M, De Gennes C, Clavel C, Mazingue F, Hammou Y, Ajana F, Hatchuel Y, Nahri I, Genet C, Ducroix-Roubert S, Aubrard Y, Constanty A, Weinbreck P, Piet E, Jacquier F, Michau C, Safwan H, Boutet A, Abdelhadi M, Elenga N, Blanche S, Delmas S, Dollfus C, Faye A, Chenadec JL, Mandelbrot L, Perilhou A, Rouzioux C, Sibiude J, Teglas JP, Tubiana R, Warszawski J.

Author information

1
CESP INSERM U1018 - Univ Paris-Sud, Le Kremlin-Bicetre.
2
Univ Diderot Paris 7 AP-HP Hôpital Robert Debré
3
AP-HP Hôpital Trousseau, Paris, France.
4
CHU St Pierre, Brussels, Belgium.
5
CESP INSERM U1018 - Univ Paris-Sud, Le Kremlin-Bicetre AP-HP Hôpital Antoine Béclère, Clamart Univ Paris-Sud.
6
Hôpital de la Croix Rousse, Lyon.
7
CESP INSERM U1018 - Univ Paris-Sud, Le Kremlin-Bicetre Univ Diderot Paris 7 AP-HP Hôpital Louis Mourier, Colombes.
8
AP-HP Hôpital Necker EA 3620 Univ Paris Descartes 5.
9
CESP INSERM U1018 - Univ Paris-Sud, Le Kremlin-Bicetre Univ Paris-Sud AP-HP Hôpital Bicetre, Paris, France.

Abstract

BACKGROUND:

Morbidity and mortality are higher among human immunodeficiency virus (HIV) exposed but uninfected (HEU) infants than unexposed infants, particularly if the mother had a low CD4 count. We investigated the possible association between maternal immune depression during pregnancy and the risk of infection in HEU infants in the national French Perinatal Cohort (EPF).

METHODS:

All neonates, born alive, to HIV-1-infected women enrolled in the EPF between 2002 and 2010 were included. The primary outcome was the first serious (hospitalization or death) infection during the first year of life. The main exposure variable was maternal CD4 cell count near delivery. The Kaplan-Meier method and multivariate Cox models were applied, with the different types of infections managed as competing events.

RESULTS:

Among 7638 HEU neonates, 699 had at least 1 serious infection (of which 159 were bacterial) with a Kaplan-Meier probability of 9.3% (95% confidence interval, 8.7-10.0) at 1 year. The risk of serious bacterial infection during the first year of life significantly increased with lower maternal CD4 cell count, before and after adjustment for maternal CD4 cell count <350 and 350-499 CD4/mm(3) (adjusted hazard ratio = 1.7 [1.2-2.6] and 1.2 [0.8-1.9], respectively; P = .03). This association mainly concerned infections involving encapsulated bacteria (P = .03). The risk of serious viral infection was, by contrast, independent of the mother's CD4 cell count.

CONCLUSIONS:

Maternal CD4 count is significantly and specifically associated with the risk of serious infections with encapsulated bacteria in HEU infants.

KEYWORDS:

CD4; HIV; infants; mother-to-child transmission; pregnancy

PMID:
25053719
DOI:
10.1093/cid/ciu586
[Indexed for MEDLINE]
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