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Predictive value of the HIV paediatric classification system for the long-term course of perinatally infected
L Galli1, M de Martino, P A Tovo
1Department of Paediatrics, University of Florence, Florence, Italy.
Insights
The Centers for Disease Control and Prevention (CDC) classification system for pediatric human immunodeficiency virus type 1 (HIV-1) infection shows some alignment with clinical outcomes but requires adjustments to infant CD4 thresholds and indicator disease distribution for improved predictive value in long-term patient management.
Area of Science:
- Pediatric Infectious Diseases
- Virology
- Immunology
Background:
- Perinatal human immunodeficiency virus type 1 (HIV-1) infection presents unique challenges in long-term management.
- Accurate classification systems are crucial for predicting disease progression and guiding treatment strategies in children.
Purpose of the Study:
- To evaluate the Centers for Disease Control and Prevention (CDC) paediatric classification system against the actual long-term clinical course of perinatally HIV-1 infected children.
- To identify potential areas for improvement in the existing classification system.
Main Methods:
- A prospective study followed 366 children with perinatal HIV-1 infection from birth, with follow-up assessments every 2 months.
- Key outcome measures included survival rates, smoothed hazard rates, adjusted hazard ratios for death, and transition probabilities between clinical and immunological categories.
Main Results:
- Overall survival at 8 years was 49%.
- The risk of death was highest before age 2, decreased between ages 2-7, and was contained thereafter.
- Children often did not progress sequentially through clinical categories; skipping Category A significantly increased the hazard ratio of death (2.5).
- Transition probabilities into Category B and C were substantial, with Category C entry more common than immunological Category 3 entry before age 2.
Conclusions:
- The CDC paediatric classification system offers a reasonable comparison to clinical reality but necessitates adjustments.
- Recommendations include revising CD4-positive cell thresholds for infants and redistributing Category B indicator diseases to enhance predictive accuracy.
- Improved classification is vital for optimizing the long-term care of children with perinatal HIV-1 infection.
Background:
To compare the Centers for Disease Control and Prevention (CDC) paediatric classification system with the long-term course of perinatal human immunodeficiency virus type 1 (HIV-1) infection.
Methods:
Prospective study on 366 perinatally infected children followed-up from birth and checked at least every 2 months. Survival, smoothed hazard, adjusted hazard ratio of death, and transition probabilities in clinical and immunological categories were outcome measures.
Results:
Survival was 49% (95% CI : 40-58%) at 8 years. The risk of death was high before the age of 2, relatively low between ages 2 and 7, and contained thereafter. Children did not advance through the categories sequentially. Survival at 8 years was 61.7% (95% CI : 49.8-73.6%) in those children who had passed through clinical category A; the hazard ratio of death was 2.5 (95% CI : 1.7-3.8) for 175 (47.9%) children who skipped this category. Transition probability in clinical category B was 39.9% (95% CI : 32.3-45.6%) after one year, but 59.1% (95% CI : 51.4-66.8%) after 5 years. Before 2 years of age, the probability of entry into category C (40%; 95% CI : 35-45%) was higher than that of entry into immunological category 3 (28%; 95% CI : 22-34%). Conclusions The classification system stands comparison with the clinical reality, but the CD4-positive cell thresholds in infancy should be adjusted and category B indicator diseases better distributed to improve their predictive value.