PMID- 18811982
OWN - NLM
STAT- MEDLINE
DCOM- 20081114
LR  - 20181113
IS  - 1471-2334 (Electronic)
IS  - 1471-2334 (Linking)
VI  - 8
DP  - 2008 Sep 24
TI  - The role of polyclonal intravenous immunoglobulin in treating HIV-infected 
      children with severe bacterial infections: a retrospective cohort study.
PG  - 127
LID - 10.1186/1471-2334-8-127 [doi]
AB  - BACKGROUND: Mortality among HIV-infected children in developing countries remains 
      high after serious bacterial infections despite the use of antibiotics. 
      Intravenous immunoglobulin (IVIG) has been used as an adjuvant therapy to treat 
      these infections, but little data exists regarding its efficacy, and previous 
      studies have focused on IVIG as a prophylactic agent. We examined the impact of 
      IVIG as an adjuvant therapy in reducing mortality and length of hospital stay in 
      HIV-infected children with serious bacterial infections. METHODS: This 
      retrospective study focused on pediatric admissions at a large urban hospital 
      between 2002 and 2006. Children between the ages of one month and nine years of 
      age with laboratory confirmed HIV-status, serious bacterial infection, no prior 
      exposure to IVIG, and a hospital length of stay of 5 days or more, were eligible 
      for inclusion. RESULTS: A total of 140 children (median age 1.2 years) met 
      inclusion criteria; lower respiratory tract infection was diagnosed in 94 (67%) 
      of the children, while 74 (53%) had bacterial sepsis. Fifty-four (39%) children 
      were receiving antiretroviral therapy and 39 (28%) were receiving tuberculosis 
      treatment. Overall 73 (52%) were treated with IVIG, with the majority (74%) of 
      children receiving a single dose. Thirteen (9%) died during their hospital 
      admission. In crude analysis IVIG was significantly associated with increased 
      mortality was (Odds Ratio (OR): 5.8; 95% Confidence Interval (CI): 1.2-27.1) and 
      this association was weakened by adjustment for other predictors of mortality (OR 
      4.3, 95% CI 0.7-27.9, p = 0.123). IVIG use was also associated with longer 
      hospital stays. CONCLUSION: Administration of one to three doses of IVIG during 
      the acute phase of illness does not appear to reduce mortality or the length of 
      hospital stays in HIV-infected children with serious bacterial infections. 
      However, the retrospective nature of this study makes confounding by indication 
      difficult to control and further studies regarding the timing, dosing, and method 
      of administration are required. Nonetheless the routine use of IVIG in 
      resource-limited settings should be carefully considered given its high cost.
FAU - Huang, Lyen C
AU  - Huang LC
AD  - Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, 
      University of Cape Town, Anzio Road, Observatory 7925, Cape Town, South Africa. 
      lyen.huang@gmail.com
FAU - Myer, Landon
AU  - Myer L
FAU - Jaspan, Heather B
AU  - Jaspan HB
LA  - eng
PT  - Journal Article
DEP - 20080924
PL  - England
TA  - BMC Infect Dis
JT  - BMC infectious diseases
JID - 100968551
RN  - 0 (Immunoglobulins, Intravenous)
SB  - IM
MH  - Bacteremia/complications/drug therapy/epidemiology/mortality
MH  - Bacterial Infections/complications/*drug therapy/epidemiology/mortality
MH  - Child, Preschool
MH  - Cohort Studies
MH  - Female
MH  - HIV/*drug effects
MH  - HIV Infections/complications/*drug therapy/epidemiology/mortality
MH  - Hospitals, Urban
MH  - Humans
MH  - Immunoglobulins, Intravenous/administration & dosage/*therapeutic use
MH  - Infant
MH  - Length of Stay
MH  - Logistic Models
MH  - Male
MH  - Retrospective Studies
MH  - South Africa/epidemiology
MH  - Treatment Outcome
PMC - PMC2570677
EDAT- 2008/09/25 09:00
MHDA- 2008/11/15 09:00
PMCR- 2008/09/24
CRDT- 2008/09/25 09:00
PHST- 2008/03/07 00:00 [received]
PHST- 2008/09/24 00:00 [accepted]
PHST- 2008/09/25 09:00 [pubmed]
PHST- 2008/11/15 09:00 [medline]
PHST- 2008/09/25 09:00 [entrez]
PHST- 2008/09/24 00:00 [pmc-release]
AID - 1471-2334-8-127 [pii]
AID - 10.1186/1471-2334-8-127 [doi]
PST - epublish
SO  - BMC Infect Dis. 2008 Sep 24;8:127. doi: 10.1186/1471-2334-8-127.