Prospective study of human immunodeficiency virus 1-related disease among 512 infants born to infected women in New York City. The New York City Perinatal HIV Transmission Collaborative Study Group.
OBJECTIVE
To determine the incidence of HIV-1-related clinical findings, mortality and predictors of death in a cohort of HIV-exposed infants followed from birth.


METHODS
Data were collected approximately bimonthly during the first and second year of life and used in Kaplan-Meier and Cox proportional hazards survival analyses to predict time to the development of symptoms and death.


RESULTS
One hundred sixteen infected and 396 uninfected infants were followed for a median of 26 months at 7 New York City hospitals from 1986 to 1995. Two or more nonspecific HIV-related symptoms, AIDS or death occurred in 83% of infected children by the first year. Fifty infected infants (43%) developed AIDS and 19 (38%) of these had Pneumocystis carinii pneumonia. Estimated median age at AIDS/death was 30 months and 64% of infected children remained alive and AIDS-free at 1 year. Estimated infant mortality among infected children was 160/1000 live births, and median survival after AIDS was 21 months; 55% of infected children survived > 12 months after diagnosis of AIDS. P. carinii pneumonia was the most common cause of death. Although birth CD4 values did not predict AIDS or death, CD4 counts as early as 6 months of age were highly correlated with both. Thirteen (68%) of 19 infants who remained AIDS-free up to 3 to 6 months of age with CD4 count < or = 1500 cells/microliters subsequently developed AIDS vs. 18 (30%) of 61 with CD4 count > 1500 (P = 0.0001).


CONCLUSIONS
Most HIV-1-infected infants develop disease in the first year of life. AIDS or death can be predicted by a threshold CD4 count of 1500 cells/microliters at 3 to 6 months of age.
Metropolitan Hospital Center, New York, NY, USA.
M
M
Bamji
D M
DM
Thea
J
J
Weedon
K
K
Krasinski
P B
PB
Matheson
P
P
Thomas
G
G
Lambert
E J
EJ
Abrams
R
R
Steketee
M
M
Heagarty
D018791:CD4 Lymphocyte Count; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000401:mortality* / Q000503:physiopathology / Q000635:transmission*; D015497:HIV-1; D006801:Humans; D015994:Incidence; D007223:Infant; D018445:Infectious Disease Transmission, Vertical; D008137:Longitudinal Studies; D009519:New York City; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious; D016016:Proportional Hazards Models; D011446:Prospective Studies; D016019:Survival Analysis