title: Changing patterns of clinical events in perinatally HIV-1-infected children during the era of HAART.
abstract: BACKGROUND
  The introduction of HAART has decreased mortality and progression to AIDS in perinatally HIV-1-infected children, but information on modification of the rate of specific clinical events is limited.
  
  
  METHODS
  An observational population study on changes in HIV-1-related morbidity was conducted on 1402 perinatally HIV-1-infected children enrolled in the Italian Register for HIV Infection in Children and prospectively followed in the pre-HAART (1985-1995) and post-HAART periods (1996-2000, and 2001-2005). Of this group, 773 children (55.1%) were followed from birth. Median observation time was 8.58 years (interquartile range, 3.71-13.72).
  
  
  RESULTS
  Overall, 666 (47.5%) children developed AIDS and 420 (29.9%) died. Improved survival over time was evidenced at Kaplan-Meier analysis (P < 0.0001). Poisson regression analysis indicated that Centers for Disease Control and Prevention class B and C clinical event rates and most of the HIV-1-related organ complication rates significantly decreased starting from 1996-2000. Significant reductions in rates of cancer and opportunistic infections were evidenced after 2000. Nevertheless, opportunistic infections still occurred at high rates (6.09/100 person-years) in 2001-2005, with high rate of bacterial infections (3.55/100 person-years), particularly pneumonia (1.66/100 person-years), in this period. CD4 cell percentage was > 15% in 58.5% children with pneumonia.
  
  
  CONCLUSIONS
  Progressive reductions of both mortality and rates of class B and C clinical events, including organ complications, were evidenced in the HAART era. Nevertheless, severe bacterial infections, particularly pneumonia, still occurred at considerable high rates, even in the absence of a severe CD4 cell depletion.
authors.affiliation: Department of Paediatrics, University of Florence, Via Luca Giordano 13, I-50132 Florence, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Chiappini
authors.forename: Luisa
authors.initials: L
authors.lastname: Galli
authors.forename: Pier-Angelo
authors.initials: PA
authors.lastname: Tovo
authors.forename: Clara
authors.initials: C
authors.lastname: Gabiano
authors.forename: Catiuscia
authors.initials: C
authors.lastname: Lisi
authors.forename: Guido Castelli
authors.initials: GC
authors.lastname: Gattinara
authors.forename: Susanna
authors.initials: S
authors.lastname: Esposito
authors.forename: Alessandra
authors.initials: A
authors.lastname: Viganò
authors.forename: Carlo
authors.initials: C
authors.lastname: Giaquinto
authors.forename: Raffaella
authors.initials: R
authors.lastname: Rosso
authors.forename: Alfredo
authors.initials: A
authors.lastname: Guarino
authors.forename: Maurizio
authors.initials: M
authors.lastname: de Martino
mesh_terms: D015526:AIDS Dementia Complex / Q000453:epidemiology; D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D002648:Child; D002675:Child, Preschool; D004812:Epidemiologic Methods; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy* / Q000453:epidemiology; D019247:HIV Wasting Syndrome / Q000453:epidemiology; D015497:HIV-1; D006801:Humans; D007223:Infant; D007558:Italy / Q000453:epidemiology; D008297:Male; D018410:Pneumonia, Bacterial / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents