Predictors of change in the functional status of children with human immunodeficiency virus infection.
OBJECTIVE
The purpose of this study was to identify important clinical predictors of change in the functional status of children with perinatally acquired human immunodeficiency virus (HIV) infection.


METHODS
Children who were perinatally exposed to HIV underwent evaluation of growth, nutritional, and functional status parameters as part of a prospective study of HIV and nutrition in children. The main outcome measures for HIV-infected children were change over time in: 1) Total Health, 2) General Health, and 3) Responsiveness as measured by the Functional Status II(R) (FSII[R]). Candidate predictors included anthropometric measurements, social factors, HIV disease stage, CD4 T lymphocyte count, medications, and other clinical markers of illness.


RESULTS
The parents or legal guardians of 35 perinatally HIV-infected children completed 2 FSII(R) surveys over a mean of 16 months. Functional Status scores were significantly correlated with number of times and days hospitalized in the past 6 months and with illness at the time of baseline evaluation. Functional status declined overtime on all 3 scales; however, only the change in Total Health score was statistically significant. Total, General Health, and Responsiveness scores declined by >/=5 points in 20.0%, 17.1%, and 14.3% of children, respectively. Significant univariate predictors of change in at least 1 component of the functional status survey included race, guardianship, height z score, prescription of antiviral medications other than antiretrovirals, and illness at time of baseline evaluation. In multivariate models, adjusting for baseline score and biologic relationship of guardian completing survey, significant predictors of a decline in Total Health scores included non-white race and lower baseline height z score. The General Health score declined with lower baseline absolute CD4 count and lower baseline height z score. Finally, Responsiveness scores declined in children whose guardian was their biologic parent and in children with lower baseline height z scores.


CONCLUSIONS
The FSII(R) questionnaire correlates with other markers of disease severity in children with HIV infection. Growth parameters, immune status, and social factors are important predictors of functional status in HIV-infected children.
Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA.
S A
SA
Missmer
D
D
Spiegelman
S L
SL
Gorbach
T L
TL
Miller
D000203:Activities of Daily Living; D000886:Anthropometry; D019380:Anti-HIV Agents / Q000627:therapeutic use; D001900:Boston; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000145:classification / Q000188:drug therapy / Q000503:physiopathology*; D006304:Health Status; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D015999:Multivariate Analysis; D009752:Nutritional Status; D011159:Population Surveillance; D011237:Predictive Value of Tests; D011446:Prospective Studies
D019380:Anti-HIV Agents