Mother-to-child transmission of the human immunodeficiency virus in Texas

BACKGROUND

The Pediatric Spectrum of HIV Diseases (PSD) project has been collecting data on HIV-exposed children in Texas since 1989. These data have now been analyzed to describe mother-to-child transmission in Texas and to provide much needed information on the magnitude of the pediatric HIV epidemic in the state.

METHODS

We examined trends in the numbers of perinatally exposed children and perinatally acquired cases of HIV in the Texas PSD cohort. We calculated transmission rates and relative risks for 656 children born from January, 1995, to July, 1998, that received all or part of the ACTG 076 regimen.

RESULTS

Only a small proportion (38%) of pairs of an HIV-infected mother and her HIV-exposed child received the full AIDS Clinical Trial Group 076 (ACTG 076) regimen; only 73% of the mothers received at least some prenatal care. In recent years, however, the numbers of perinatally exposed children and perinatally acquired cases of HIV have decreased in Texas. Univariate analyses showed that a reduction in the vertical transmission of HIV was associated with receipt of a full ACTG 076 regimen, receipt of a partial ACTG 076 regimen and residence in Dallas County.

CONCLUSIONS

Findings identify a gap in meeting the health care needs of pregnant HIV-infected women and suggest missed opportunities to prevent mother-to-child transmission of HIV. At the same time this study confirms progress in prevention efforts to reduce mother-to-child transmission of HIV in Texas.

Postinflammatory hydrocephalus and intracranial mass lesion from Candida in an immunocompetent child

Central nervous system Candida infection may occur in systemic Candida infection when host defenses are impaired. We report here a 20-month-old boy with normal immune status and no history of immunosuppressive therapy who developed left facial weakness, decreased left hand strength and coordination, and worsening gait. This paper describes the diagnostic procedures and management strategies employed in this unique case.

Facial cellulitis: an early indicator of group B streptococcal bacteremia

Epithelial manifestations as indicators of group B streptococcal (GBS) bacteremia have been infrequently reported in the literature. This report describes three infants, ranging in age from 2 1/2 weeks to 7 weeks, who were seen with facial cellulitis as the only sign of GBS bacteremia. Only one of these infants had fever on presentation; otherwise, there were no signs of systemic illness. "Spontaneous cellulitis" should be viewed as an indicator of underlying bacteremia; in an infant less than 3 months of age, GBS should be considered a prime etiologic agent.