Changing patterns of clinical events in perinatally HIV-1-infected children during the era of HAART.
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.
Chiappini
Elena
E
Department of Paediatrics, University of Florence, Via Luca Giordano 13, I-50132 Florence, Italy.
Galli
Luisa
L
Tovo
Pier-Angelo
PA
Gabiano
Clara
C
Lisi
Catiuscia
C
Gattinara
Guido Castelli
GC
Esposito
Susanna
S
Viganò
Alessandra
A
Giaquinto
Carlo
C
Rosso
Raffaella
R
Guarino
Alfredo
A
de Martino
Maurizio
M
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
D019380:Anti-HIV Agents