Influence of institutionalization on time to HIV disease progression in a cohort of Romanian children and teens.
OBJECTIVE
The purpose of this work was to investigate the effect of institutionalization on death and CD4 decline in a cohort of 325 HIV-infected Romanian children.


METHODS
A retrospective database analysis was conducted. Data from a nearly 3-year period were examined with Kaplan-Meier survival analysis and Cox regression analysis models. Subjects all received primary and HIV specialty care and treatment at the Romanian American Children's Center in Constanta, Romania. Children in one group resided with their biological families and the other children resided in "family home"-style institutions.


RESULTS
There was no difference between groups for death during the follow-up period, although there was a trend for survival advantage for children in institutional care. There was no statistically significant difference between the study groups in terms of CD4 decline, although there was a trend toward greater decline among children who resided with their biological families. Children with their biological families were more likely to experience disease progression through either death or CD4 decline than were children in institutions.


CONCLUSIONS
The family home-style institution may prove to be a replicable model for the safe and appropriate care of HIV-infected orphaned and abandoned children and teens.
Baylor College of Medicine, Department of Pediatrics, 6621 Fannin St, CCC1210, Houston, TX 77030, USA. mferris@bcm.edu
Margaret
M
Ferris
Keith
K
Burau
Ana Maria
AM
Constantin
Stefania
S
Mihale
Nancy
N
Murray
Alina
A
Preda
Michael
M
Ross
Mark W
MW
Kline
D000293:Adolescent; D002648:Child; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000401:mortality* / Q000628:therapy; D006801:Humans; D007326:Institutionalization / Q000706:statistics & numerical data*; D008297:Male; D012383:Romania