title: Causes of death in pediatric patients vertically infected by the human immunodeficiency virus type 1 in Madrid, Spain, from 1982 to mid-2009.
abstract: BACKGROUND
  Effective therapies have increased life expectancy of human immunodeficiency virus (HIV)-infected pediatric patients. We investigated the underlying causes of death, mortality, and acquired immune deficiency syndrome (AIDS) rates in HIV-infected pediatric patients in Madrid, Spain.
  
  
  METHODS
  We studied a multicenter cohort of 478 HIV-infected pediatric patients in Madrid. Mortality and AIDS incidence rates, causes of death, CD4 T-cell, and HIV RNA were analyzed during calendar periods (CPs): pre-HAART (highly active antiretroviral therapy) (CP1: 1982-1996) and post-HAART era (CP2: 1997-2009).
  
  
  RESULTS
  During 5690 person-years of follow-up 157 (32.8%) deaths occurred. Median age at death increased (CP1: 3.2 years [1.0-6.3] vs. CP2: 7.7 years [3.1-11.4]; P < 0.01). Mortality and AIDS rates decreased 10.6-fold (95% confidence intervals [CI]: 6.9-16.7) and 6.9-fold (95% CI: 5.0-9.6), respectively, between CPs. Nevertheless, mortality was 10.4-fold (95% CI: 5.8-18.8; P < 0.001) higher than in age-similar general population in late-CP2. In all, 169 causes of death were reported. Multiple causes were reported in 16 of 151 (10.6%) patients. In 81.1% (137/169), the causes were AIDS-defining, 11.8% (20/169) HIV-related, and 7.1% (12/169) non-HIV-related. Infections were the leading causes (60.8%, 101/166); from 1999 to 2007 the risk of death from infections was 115.9 times (95% CI: 42.0-265.8; P < 0.001) higher than in the age-similar general population. Comorbidity was reported in 66.9% (101/151) of patients. Median HIV-1 RNA at death decreased (CP1: 5.9 [5.0-6.3]; CP2: 5.3 [4.2-5.8]; P < 0.01).
  
  
  CONCLUSIONS
  Despite decline in mortality and AIDS rates, it is important to monitor all causes of death as prolonged survival might allow underlying comorbidity to become more clinically relevant.
authors.affiliation: Laboratorio de Inmuno-Biología Molecular, Hospital General Universitario "Gregorio Marañón," Madrid, Spain.
authors.forename: Claudia
authors.initials: C
authors.lastname: Palladino
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Climent
authors.forename: M Isabel De
authors.initials: MI
authors.lastname: José
authors.forename: Santiago
authors.initials: S
authors.lastname: Jimenez De Ory
authors.forename: Jose María
authors.initials: JM
authors.lastname: Bellón
authors.forename: Sara
authors.initials: S
authors.lastname: Guillén
authors.forename: M Dolores
authors.initials: MD
authors.lastname: Gurbindo
authors.forename: Isabel
authors.initials: I
authors.lastname: González-Tomé
authors.forename: M José
authors.initials: MJ
authors.lastname: Mellado
authors.forename: Jorge
authors.initials: J
authors.lastname: Martínez Pérez
authors.forename: Cristina
authors.initials: C
authors.lastname: Calvo
authors.forename: José Tomás
authors.initials: JT
authors.lastname: Ramos
authors.forename: M Angeles
authors.initials: MA
authors.lastname: Muñoz-Fernández
mesh_terms: D000293:Adolescent; D018791:CD4 Lymphocyte Count; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000401:mortality* / Q000635:transmission / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification; D006801:Humans; D015994:Incidence; D007223:Infant; D018445:Infectious Disease Transmission, Vertical; D008297:Male; D012367:RNA, Viral / Q000097:blood; D013030:Spain / Q000453:epidemiology; D019562:Viral Load
chemical_list: D012367:RNA, Viral