HIV vertically exposed uninfected child with severe infections: evidence of immunodeficiency?

Abstract

Objective: HIV vertically exposed uninfected children are often subjected to a greater risk
of infectious and non-infectious complications compared to pediatric population not exposed
to the virus. The objective of this study is to report the case of an HIV-exposed uninfected
child that presented three serious infectious complications.
Case Description: This is a child born from a mother consumer of cocaine, alcoholic, HIV-
-positive since 2006 on antiretroviral from the second trimester of this pregnancy. Specialist
antenatal care, asymptomatic during pregnancy, CD4 count of 995 cells/mm3 and an undetectable viral load near childbirth. Received intravenous zidovudine peripartum. Newborn was transferred to the ICU with respiratory distress requiring mechanical ventilation. The child was hospitalized for 38 days presenting two features of neonatal sepsis (blood cultures positive for Enterobacter and Serratia mascences on different times). During follow-up, at Pediatric Infectious Diseases Service, she presented an episode of pneumonia in the second semester of life and perineal candidiasis, upper respiratory tract infection, pertussis syndrome and two episodes of bronchiolitis, being hospitalized on two occasions. She presented three undetectable viral loads and a negative anti-HIV test, being discharged from the service after excluding HIV infection.
Discussion: Although HIV-uninfected, the patient had a severe and early clinic with presence
of three systemic infections, suggesting immunodeficiency. The observation of the frequency
of infectious complications in this group may contribute to a better approach and a more
appropriate intervention with the goal of reducing morbidity and mortality in this population.