A descriptive study of HIV-infected long-term surviving children in Barbados--a preliminary report.
OBJECTIVE
To describe the clinical and immunologic characteristics of human immunodeficiency virus type-1 (HIV-1)-infected children surviving to more than eight-years of age (long-survivors) before the introduction of antiretroviral therapy.


METHODS
This report is based on all the long-term survivors from a prospective cohort of HIV-infected children born to HIV-positive women in Barbados during 1986-1995. Infants born to HIV-infected women were enrolled into this cohort at birth or at the time of diagnosis of HIV exposure in the postnatal period and followed-up at regular intervals.


RESULTS
From a cohort of 44 HIV-infected children, 17 (38.6%) children survived to the age of eight years and beyond and were classified as long-term survivors. Median age of the sixteen long-term surviving children alive at the time of this report was 12 years (age range 8 - 16.7 years). At the age of 8 years, 17.6% of these children remained asymptomatic. Nine (52.9%) children had no immunodeficiency (CD4 counts >500 cells x 10(6)/L). Of the 16 long-term surviving children who were alive and had a median follow-up of 4.1 years (range 0.1 year to 8.5 years) after their eighth birthday, 37.5% had a CD4 cell count greater than 500 cells x 10(6)/L and had either no symptoms or only mild symptoms of HIV infection and were therefore categorized as the long-term non-progressors.


CONCLUSIONS
In a small cohort of HIV-infected children, in the absence of antiretroviral therapy, only about one-third survived beyond eight years of age. On further follow-up of these long-term surviving children, over one-third had a slow rate of disease progression.
Kumar
A
A
Department of Paediatrics, Queen Elizabeth Hospital and School of Clinical Medicine and Research, The University of the West Indies, Cave Hill, Barbados. bhavna@sunbeach.net
St John
M A
MA
Lewis
D
D
D000293:Adolescent; D001460:Barbados / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D002648:Child; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000401:mortality*; D015497:HIV-1; D006801:Humans; D008297:Male; D011446:Prospective Studies; D015996:Survival Rate