In the Journals

HIV-exposed, uninfected kids hospitalized at twice the rate of unexposed kids

Photo of Sarah Labuda
Sarah M. Labuda

In the United States, children born to mothers with HIV but who are not infected with the virus are hospitalized at more than twice the rate of children born to mothers without HIV, according to research published in Clinical Infectious Diseases. They also face twice the rate of hospitalization from infections.

“This has previously been shown in children born to mothers with HIV in countries with much higher rates of HIV and more limited medical care, but our study is the first showing the increased risk of hospitalization even in children born to mothers with HIV in the United States,” Sarah M. Labuda, MD, MPH, a pediatric infectious diseases fellow at Tulane University Medical Center, told Infectious Diseases in Children.

According to Labuda, approximately 1 million children are born to mothers with HIV each year worldwide, but “the great success” is that most of these children are HIV-exposed and uninfected (HEU) children. However, this results in a large group of children who are at a higher risk for being sick enough to be hospitalized before their second birthday, likely because these children have evidence of changes in their immune system that might be due to the mother’s HIV infection and inflammation present during pregnancy, Labuda noted.

The researchers analyzed data from patients enrolled in the Surveillance Monitoring for ART Toxicities Study (SMARTT) cohort who were born between 2006 and 2017. They obtained comparison data for HIV-unexposed, uninfected (HUU) children from the Medicaid Analytic Extract database and restricted analysis to states participating in SMARTT. They used multivariable Poisson regression models to evaluate associations of maternal HIV factors with risk for hospitalization.

Infographic about prenatal HIV exposure and rate of future hospitalization in the first 2 years of life 

The researchers included a total of 2,404 HEU children and 3,605,864 HUU children in the analysis. In the first 2 years of life, HEU children had more than twice the rate of first hospitalization (8.27/1,000 person-months vs. 3.67/1,000 person-months) and first hospitalization with an infectious diagnosis (5.8/1,000 person-months vs. 2.51/1,000 person-months), with approximately twofold higher rates of first (incidence rate ratio [IRR] = 2.25; 95% CI, 2.01-2.52) and first infection-related (IRR = 2.31; 95% CI, 2.02-2.64)) hospitalization, compared with HUU children. Total hospitalizations also were more than two times higher in HEU than HUU for both first infection-related (IRR = 2.31; 95% CI, 2.02-2.64) and total infection-related (IRR = 2.17; 95% CI, 1.92-2.44) hospitalizations. However, the researchers reported no significant difference in mortality and no significant association between maternal HIV characteristics and child hospitalizations.

“Many researchers are currently working on better understanding what these immune system differences are and how we might prevent the infections and hospitalizations in these children,” Labuda said. – by Joe Gramigna

Disclosures: Labuda reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

Photo of Sarah Labuda
Sarah M. Labuda

In the United States, children born to mothers with HIV but who are not infected with the virus are hospitalized at more than twice the rate of children born to mothers without HIV, according to research published in Clinical Infectious Diseases. They also face twice the rate of hospitalization from infections.

“This has previously been shown in children born to mothers with HIV in countries with much higher rates of HIV and more limited medical care, but our study is the first showing the increased risk of hospitalization even in children born to mothers with HIV in the United States,” Sarah M. Labuda, MD, MPH, a pediatric infectious diseases fellow at Tulane University Medical Center, told Infectious Diseases in Children.

According to Labuda, approximately 1 million children are born to mothers with HIV each year worldwide, but “the great success” is that most of these children are HIV-exposed and uninfected (HEU) children. However, this results in a large group of children who are at a higher risk for being sick enough to be hospitalized before their second birthday, likely because these children have evidence of changes in their immune system that might be due to the mother’s HIV infection and inflammation present during pregnancy, Labuda noted.

The researchers analyzed data from patients enrolled in the Surveillance Monitoring for ART Toxicities Study (SMARTT) cohort who were born between 2006 and 2017. They obtained comparison data for HIV-unexposed, uninfected (HUU) children from the Medicaid Analytic Extract database and restricted analysis to states participating in SMARTT. They used multivariable Poisson regression models to evaluate associations of maternal HIV factors with risk for hospitalization.

Infographic about prenatal HIV exposure and rate of future hospitalization in the first 2 years of life 

The researchers included a total of 2,404 HEU children and 3,605,864 HUU children in the analysis. In the first 2 years of life, HEU children had more than twice the rate of first hospitalization (8.27/1,000 person-months vs. 3.67/1,000 person-months) and first hospitalization with an infectious diagnosis (5.8/1,000 person-months vs. 2.51/1,000 person-months), with approximately twofold higher rates of first (incidence rate ratio [IRR] = 2.25; 95% CI, 2.01-2.52) and first infection-related (IRR = 2.31; 95% CI, 2.02-2.64)) hospitalization, compared with HUU children. Total hospitalizations also were more than two times higher in HEU than HUU for both first infection-related (IRR = 2.31; 95% CI, 2.02-2.64) and total infection-related (IRR = 2.17; 95% CI, 1.92-2.44) hospitalizations. However, the researchers reported no significant difference in mortality and no significant association between maternal HIV characteristics and child hospitalizations.

“Many researchers are currently working on better understanding what these immune system differences are and how we might prevent the infections and hospitalizations in these children,” Labuda said. – by Joe Gramigna

Disclosures: Labuda reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.