AEGiS-08IAC: Natural history of HIV infection in Ugandan infants.

8th International AIDS Conference

Amsterdam, Netherlands — July 19-24, 1992

Natural history of HIV infection in Ugandan infants.

Int Conf AIDS 1992 Jul 19-24; 8:We56 (abstract no. WeC 1058)
Hom D, Guay L, Kenya-Mugisha N, Ball P, Olness K, Ndugwa C, Kataaha P, Goldfarb J; Case Western Reserve University, Cleveland, OH.

OBJECTIVES: Determine the natural history and vertical transmission of HIV infection in infants born to HIV infected women in Kampala, Uganda.

METHODS: Infants of selected HIV positive and negative women were prospectively followed in a study of HIV infection. History and physical exam were done at regularly scheduled clinic visits where investigators were blind to HIV status. Infant HIV serology was determined at 12 and 18 mos. with western blot confirmation.

RESULTS: Of 565 infants actively followed, 470 would now be 18 mos. old, with 335 born to positive and 130 to negative mothers. Of 73 deaths, 68 were infants born to positive (20.2%), and 5 to negative mothers (3.8%, p less than .0001). Mean age at death was 7.8 +/- 4.8 mos. for both groups. Of 68 infant deaths to positive mothers, two-thirds had either AIDS by WHO or CDC criteria (25%), or symptoms suggestive of HIV infection (43%) at death. Six infants (9%) died with no symptoms of HIV infection. Failure to thrive (58% vs. 12%), generalized lymphadenopathy (58% vs. 26%) and splenomegaly (35% vs. 13%) were the best (p less than .0001) predictors for mortality among infants born to HIV positive mothers. Of the remaining 267 infants born to positive mothers alive at 18 months, 37 were HIV infected (13.8%, 95% CI: 9.7-17.9%). This rate is higher when adjusted for deaths (47) attributed to or suggestive of HIV infection (26.7%, 95% CI: 21.8-31.6%). Several major factors were significantly associated with HIV infection. These included prolonged diarrhea, hepatomegaly, developmental delay, parotitis, skin infections, generalized lymphadenopathy and failure to thrive. By 18 mos., 53% had AIDS, 37% had symptoms of HIV infection, and 10% had no symptoms. No factors differentiated the 230 uninfected infants born to infected mothers from the 130 infants born to uninfected mothers.

CONCLUSIONS: Vertical transmission in this breastfed cohort ranges from 14 to 27 percent. Uninfected infants born to HIV positive mothers could not be distinguished clinically from the uninfected infants born to HIV negative mothers. Ninety percent of HIV infected infants were symptomatic by age 18 months.

Keywords: AEGIS, HIV Infections, Disease Transmission, Vertical, Acquired Immunodeficiency Syndrome, HIV Seropositivity, Mothers, Breast Feeding, Infant Mortality, Uganda, Infant, Human, Female, transmission, ICA8
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