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Epidemiology of pediatric AIDS in Puerto Rico: 1981-1998
R Perez-Perdomo1, C M Perez-Cardona, E L Suarez-Perez
1University of Puerto Rico, Graduate School of Public Health, San Juan. ros_perez@rcmaca.upr.clu.edu
Insights
This study analyzed pediatric AIDS cases in Puerto Rico, finding Pneumocystis pneumonia and wasting syndrome as common AIDS-defining conditions. Survival was shorter for infants and those with specific infections, differing from US data.
Area of Science:
- Pediatric Infectious Diseases
- Epidemiology
- Public Health
Background:
- Pediatric Acquired Immunodeficiency Syndrome (AIDS) remains a significant global health concern.
- Understanding the specific characteristics and outcomes of pediatric AIDS cases is crucial for targeted interventions.
- Puerto Rico has a unique epidemiological profile that warrants specific investigation.
Purpose of the Study:
- To describe the AIDS-defining conditions (ADC) in pediatric AIDS cases in Puerto Rico.
- To analyze the survival experience of children diagnosed with AIDS in Puerto Rico.
- To compare findings with those reported in the United States.
Main Methods:
- Descriptive analysis of 377 pediatric AIDS cases reported from 1981 to 1998.
- Kaplan-Meier method for survival curve estimation.
- Wilcoxon test for comparing survival differences.
Main Results:
- Most cases (61%) were diagnosed before age 2, with 94% acquired through perinatal transmission.
- Common AIDS-defining conditions included Pneumocystis carinii pneumonia (PCP) (23%), wasting syndrome (19.4%), and esophageal candidiasis (19.1%).
- Overall median survival was 53.5 months; infants (<1 year) had significantly shorter survival. Survival differed significantly for children with PCP, pulmonary candidiasis, cytomegalovirus, and LIP.
Conclusions:
- Pediatric AIDS in Puerto Rico presented with distinct common ADC and survival patterns compared to the US.
- Younger age at diagnosis and specific opportunistic infections were associated with poorer survival outcomes.
- Differences may stem from variations in diagnostic or reporting practices between Puerto Rico and the US.
Abstract:
The objective of this study was to describe the AIDS-defining conditions (ADC) and survival experience of pediatric AIDS cases (< 13 years age) reported in Puerto Rico. A descriptive analysis of the data gathered by the Puerto Rico AIDS Surveillance System was performed. Data for the 377 pediatric AIDS cases reported from January 1981 through June 1998 were reviewed. Survival curves following AIDS diagnosis were estimated using the Kaplan--Meier method and differences between curves were assessed by the Wilcoxon test. The majority (61%) of the cases were diagnosed before 2 years of age, and nearly 94% of them acquired the infection through perinatal transmission. The most common ADC were Pneumocystis carinii pneumonia (PCP) (23%), wasting syndrome (19.4%), and esophageal candidiasis (19.1%). The overall median survival time during the study period was 53.5 (95% CI: 38.0-106.2) months. Children < 1 year of age had a significantly shorter median survival time compared with older ages (p < 0.05). The survival experience in children diagnosed with PCP, pulmonary candidiasis, cytomegalovirus, and lymphocytic interstitial pneumonia (LIP) was significantly different (p < 0.05) to those children not diagnosed with these conditions. Although patients diagnosed after 1990 showed a median survival time longer than those diagnosed prior to 1990, the difference did not reach statistical significance (p > 0.05). The frequency of several ADC and median survival time of Puerto Rican children differed from those reported in the United States. This may reflect differences in diagnostic procedures or reporting practices.