Early neurodevelopmental markers predictive of mortality in infants infected with HIV-1.
One-hundred and fifty-seven vertically infected HIV-1 positive infants (85 males, 72 females) underwent longitudinal assessment to determine whether early neurodevelopmental markers are useful predictors of mortality in those infants who survive to at least 4 months of age. Survival analysis methods were used to estimate time to death for quartiles of 4-month scores (baseline) on the Bayley Scales of Infant Development (BSID). Cox proportional hazards progression was used to estimate relative hazard (RH, 95% CI) of death for BSID scores and potential confounders. Thirty infants with BSID scores at 4 months of age died during follow-up. Survival analysis revealed greater mortality rates in infants with BSID (Mental Developmental Index and Psychomotor Developmental Index) scores in the lower quartile (p=0.004, p=0.036). Unadjusted univariate analyses revealed increased mortality associated with baseline CD4+ 29%, gestational age <37 weeks, smaller head circumference, advanced HIV and higher plasma viral load. BSID scores independently predicted mortality after adjusting for treatment, clinical category, gestational age, plasma viral load and CD4+ percentage.
Llorente
Antolin
A
The Neuropsychology Progam, Mt Washington Pediatric Hospital, 1708 West Rogers Avenue, Baltimore, MD 21209-4596, USA. allorente@mwph.org
Brouwers
Pim
P
Charurat
Manhattan
M
Magder
Laurence
L
Malee
Kathleen
K
Mellins
Claude
C
Ware
Janice
J
Hittleman
Joan
J
Mofenson
Lynne
L
Velez-Borras
Jesus
J
Adeniyi-Jones
Samuel
S
D000367:Age Factors; D000704:Analysis of Variance; D018791:CD4 Lymphocyte Count; D002658:Developmental Disabilities / Q000145:classification / Q000175:diagnosis* / Q000821:virology*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000401:mortality* / Q000635:transmission; D015497:HIV-1; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D018445:Infectious Disease Transmission, Vertical; D008297:Male; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis; D019562:Viral Load