Incidence of Opportunistic and Other Infections in HIV-Infected Children in the HAART Era

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Abstract
The human immunodeficiency virus (HIV) epidemic has spurred the development of new antiretroviral, immune, and vaccine-based therapies geared to block vertical transmission, prevent disease progression, and prolong the survival of individuals who are HIV positive. HAART has dramatically decreased rates of AIDS-related opportunistic complications and deaths in adults.1-5 The Swiss HIV Cohort Study, involving 2410 HIV-infected persons 16 years or older, reported that incidence rates (IRs) for all opportunistic infections combined had rapidly decreased from 15.1 per 100 person-years before therapy to 7.7 in the first 3 months after starting treatment, 2.6 in the following 6 months, and 2.2 between 9 and 15 months later.6 Due to advances in the treatment of HIV infection including HAART, earlier diagnosis of infection status in exposed infants and quantitative virology and immunologic monitoring, HIV-infection has become a chronic illness with substantially reduced mortality among children.7-10 Immune reconstitution engendered by HAART in HIV-positive children has significantly lowered mortality and frequency of bacterial infections and opportunistic infections, such as Pneumocystis jeroveci and disseminated Mycobacteriumavium complex, compared with the pre-HAART era.11

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