{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T11:04:24Z","timestamp":1791198264483,"version":"4.1.0"},"reference-count":39,"publisher":"American Academy of Pediatrics (AAP)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[1999,11,1]]},"abstract":"Objective.<\/jats:title>To compare morbidity and mortality of human immunodeficiency virus type 1 (HIV-1)-infected and HIV-1-uninfected children and to identify predictors of acquired immunodeficiency syndrome (AIDS) and death among HIV-1-infected children in the context of a developing country.<\/jats:p><\/jats:sec>Design.<\/jats:title>Prospective cohort study.<\/jats:p><\/jats:sec>Setting.<\/jats:title>Maternal and child health clinic of the Centre Hospitalier de Kigali, Rwanda.<\/jats:p><\/jats:sec>Participants.<\/jats:title>Two hundred eighteen children born to HIV-1-seropositive mothers and 218 born to seronegative mothers of the same age and parity were enrolled at birth.<\/jats:p><\/jats:sec>Outcome Measures.<\/jats:title>Deaths, clinical AIDS, nonspecific HIV-related manifestations, and use of health care services.<\/jats:p><\/jats:sec>Results.<\/jats:title>Fifty-four infected and 347 uninfected children were followed up for a median of 27 and 51 months, respectively. With the exception of chronic cough, the risk of occurrence of nonspecific HIV-related conditions was 3 to 13 times higher in infected than in uninfected children. The recurrence rate and severity of these findings were increased systematically in infected infants. Estimated cumulative risk of developing AIDS was 28% and 35% at 2 and 5 years of age, respectively. Estimated risk of death among infected children at 2 and 5 years of age was 45% and 62%, respectively, a rate 21 times higher than in uninfected children. Median survival time after estimated infection was 12.4 months. Early infection, early onset of HIV-related conditions, failure to thrive, and generalized lymphadenopathy were associated with subsequent risk of death and\/or AIDS, whereas lymphoid interstitial pneumonitis was predictive of a milder disease.<\/jats:p><\/jats:sec>Conclusions.<\/jats:title>In Africa, HIV-1-infected children develop disease manifestations early in life. Specific clinical findings are predictive of HIV-1 disease, AIDS stage, and death. Bimodal expression of HIV-1 pediatric disease is encountered in Africa, as in industrialized countries, but prognosis is poorer. human immunodeficiency virus infection, children, vertical transmission, natural history, Africa.<\/jats:p><\/jats:sec>","DOI":"10.1542\/peds.104.5.e56","type":"journal-article","created":{"date-parts":[[2004,8,13]],"date-time":"2004-08-13T23:45:45Z","timestamp":1092440745000},"page":"e56-e56","source":"Crossref","is-referenced-by-count":183,"title":["Natural History of Human Immunodefiency Virus Type 1 Infection in Children: A Five-Year Prospective Study in Rwanda"],"prefix":"10.1542","volume":"104","author":[{"given":"Rosemary","family":"Spira","sequence":"first","affiliation":[{"name":"From the Unite\u0301 INSERM U 330, Universite\u0301 Victor Segalen Bordeaux 2, Bordeaux, France; the"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippe","family":"Lepage","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Centre 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