Maternal health factors and early pediatric antiretroviral therapy influence the rate of perinatal HIV-1 disease progression in children.
OBJECTIVE
To determine the relationship of maternal health factors and infant antiretroviral treatment to the risk of pediatric disease progression to AIDS or death by 24 months of age.


METHODS
Prospective perinatal HIV-1 transmission and pediatric natural history study.


METHODS
Urban medical centers in four cities in the USA.


METHODS
A total of 2656 pregnant and postpartum HIV-infected women enrolled in the Perinatal AIDS Collaborative Transmission Study (PACTS) and 360 children determined to be HIV-infected.


METHODS
Pediatric AIDS or death by 24 months of age.


RESULTS
Children born to mothers with class C disease, CD4 cell count < 200 x 106/l, or HIV-1 RNA viral load > 100 000 copies/ml progressed more rapidly than children born to mothers with less advanced disease. In a multivariate analysis, there was an increased risk of progression if mothers had Class C disease [relative risk (RR), 1.7; 95% confidence interval (CI), 1.0-2.7] or HIV-1 RNA > 100 000 copies/ml (RR, 2.4; 95% CI, 1.2-4.6) controlling for child antiretroviral therapy and year of birth. Earlier years of birth significantly increased the likelihood of rapid progression (P = 0.01) in this multivariate model. Children who received combination antiretroviral therapies with a protease inhibitor or non-nucleoside reverse transcriptase inhibitor were significantly less likely to progress compared with those receiving no therapy (P = 0.03).


CONCLUSIONS
HIV-1-infected infants born to women with advanced HIV-1 disease were at increased risk for rapid disease progression. More recent birth year and early treatment with potent antiretroviral therapy significantly diminished the likelihood of developing AIDS or dying during early childhood.
Abrams
Elaine J
EJ
Harlem Hospital Center and Columbia University, College of Physicians & Surgeons, New York, New York 10037, USA.
Wiener
Jeffrey
J
Carter
Rosalind
R
Kuhn
Louise
L
Palumbo
Paul
P
Nesheim
Stephen
S
Lee
Francis
F
Vink
Peter
P
Bulterys
Marc
M
D000163:Acquired Immunodeficiency Syndrome / Q000517:prevention & control; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D018791:CD4 Lymphocyte Count; D018450:Disease Progression; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000635:transmission; D017320:HIV Protease Inhibitors / Q000008:administration & dosage; D015497:HIV-1; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D015999:Multivariate Analysis; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000276:immunology / Q000821:virology; D011297:Prenatal Exposure Delayed Effects; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D019562:Viral Load
D019380:Anti-HIV Agents; D017320:HIV Protease Inhibitors