Richardson Barbra A, Nduati Ruth, Mbori-Ngacha Dorothy, Overbaugh Julie, John-Stewart Grace C
Department of Biostatistics, University of Washington, Seattle, Washington, USA.
Clin Infect Dis. 2008 Jan 15;46(2):289-95. doi: 10.1086/524748.
Clinical signs and symptoms of acute human immunodeficiency virus (HIV) infection in infants are not well characterized.
Serial clinical assessments and HIV PCR assays were conducted in a cohort of children born to HIV-seropositive mothers from birth to 2 years of age. Acute HIV infection visits were defined as those up to 3 months prior to and including the visit at which HIV DNA was first detected. Noninfection visits included all visits at which the child had test results negative for HIV, including the last visit at which a test result negative for HIV DNA was obtained in children who later acquired HIV infection. Differences in the prevalence of symptoms at acute infection versus noninfection visits were determined overall and were stratified by age at infection (<2 months vs. >or=2 months). HIV RNA was measured serially in infected infants and was compared between infants with and infants without symptoms of acute HIV infection.
There were 125 acute infection visits (among 56 infants) and 3491 noninfection visits (among 306 infants). Acute HIV infection was associated with rash (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.1-2.8), failure to thrive (OR, 1.9; 95% CI, 1.0-3.5), and lymphadenopathy (OR, 2.5; 95% CI, 1.4-4.8). Acute HIV infection was associated with lymphadenopathy (OR, 2.6; 95% CI, 1.3-5.0) in infants <2 months of age and with pneumonia (OR, 3.2; 95% CI, 1.1-9.3) and dehydration (OR, 6.0; 95% CI, 1.9-18.5) in infants >or=2 months of age. Infant peak viral load and mortality were not associated with symptoms of acute HIV infection. However, infants with symptoms had higher viral levels later in the course of infection than did those without symptoms (P=.05).
Infants may manifest symptoms early during the course of HIV infection, and symptoms of acute HIV infection may correlate with poor viral control. Rash, failure to thrive, lymphadenopathy, pneumonia, and dehydration may signify acute HIV infection in infants.
婴儿急性人类免疫缺陷病毒（HIV）感染的临床体征和症状尚未得到充分描述。
对一组HIV血清阳性母亲所生儿童从出生至2岁进行系列临床评估和HIV聚合酶链反应（PCR）检测。急性HIV感染就诊定义为首次检测到HIV DNA之前及包括该次就诊在内的前3个月内的就诊。非感染就诊包括儿童HIV检测结果为阴性的所有就诊，包括后来感染HIV的儿童最后一次HIV DNA检测结果为阴性的就诊。总体确定急性感染就诊与非感染就诊时症状患病率的差异，并按感染时年龄（<2个月与≥2个月）分层。对感染婴儿连续检测HIV RNA，并比较有和没有急性HIV感染症状的婴儿之间的情况。
有125次急性感染就诊（56名婴儿）和3491次非感染就诊（306名婴儿）。急性HIV感染与皮疹（比值比[OR]，1.8；95%置信区间[CI]，1.1 - 2.8）、生长发育不良（OR，1.9；95% CI，1.0 - 3.5）和淋巴结病（OR，2.5；95% CI，1.4 - 4.8）相关。急性HIV感染在<2个月龄婴儿中与淋巴结病（OR，2.6；95% CI，1.3 - 5.0）相关，在≥2个月龄婴儿中与肺炎（OR，3.2；95% CI，1.1 - 9.3）和脱水（OR，6.0；95% CI，1.9 - 18.5）相关。婴儿的病毒载量峰值和死亡率与急性HIV感染症状无关。然而，有症状的婴儿在感染过程后期的病毒水平高于无症状婴儿（P = 0.05）。
婴儿可能在HIV感染过程早期出现症状，急性HIV感染症状可能与病毒控制不佳相关。皮疹、生长发育不良、淋巴结病、肺炎和脱水可能表明婴儿患有急性HIV感染。
