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Predictors of change in the functional status of children with human immunodeficiency virus infection
S A Missmer1, D Spiegelman, S L Gorbach
1Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA.
Insights
Functional status in children with perinatally acquired human immunodeficiency virus (HIV) declines over time, influenced by factors like race and growth parameters. Lower height z-scores and non-white race predict worsening total health in these children.
Area of Science:
- Pediatrics
- Infectious Diseases
- Clinical Medicine
Background:
- Perinatally acquired human immunodeficiency virus (HIV) infection presents unique challenges in pediatric care.
- Monitoring functional status is crucial for assessing the overall health and well-being of children living with HIV.
- Identifying predictors of functional decline can inform targeted interventions and improve patient outcomes.
Purpose of the Study:
- To identify key clinical predictors associated with changes in functional status among children with perinatally acquired HIV.
- To understand the relationship between various health parameters and the functional trajectory of HIV-infected children.
Main Methods:
- A prospective study evaluated growth, nutritional, and functional status in perinatally HIV-exposed children.
- Functional Status II(R) (FSII[R]) was used to measure changes in Total Health, General Health, and Responsiveness over time.
- Candidate predictors included anthropometric data, social factors, HIV disease stage, CD4 counts, and clinical markers.
Main Results:
- Functional status scores declined across all three FSII(R) scales in HIV-infected children over a mean of 16 months.
- Significant predictors of decline included non-white race, lower baseline height z-score, lower CD4 count, and illness severity.
- Hospitalization frequency and baseline illness correlated with functional status scores.
Conclusions:
- The FSII(R) questionnaire is a valuable tool that correlates with disease severity in children with HIV.
- Growth parameters, immune status (CD4 count), and social factors are significant predictors of functional status in this population.
- These findings highlight the importance of a holistic approach to managing children with perinatally acquired HIV.
Objective:
The purpose of this study was to identify important clinical predictors of change in the functional status of children with perinatally acquired human immunodeficiency virus (HIV) infection.
Methods:
Children who were perinatally exposed to HIV underwent evaluation of growth, nutritional, and functional status parameters as part of a prospective study of HIV and nutrition in children. The main outcome measures for HIV-infected children were change over time in: 1) Total Health, 2) General Health, and 3) Responsiveness as measured by the Functional Status II(R) (FSII[R]). Candidate predictors included anthropometric measurements, social factors, HIV disease stage, CD4 T lymphocyte count, medications, and other clinical markers of illness.
Results:
The parents or legal guardians of 35 perinatally HIV-infected children completed 2 FSII(R) surveys over a mean of 16 months. Functional Status scores were significantly correlated with number of times and days hospitalized in the past 6 months and with illness at the time of baseline evaluation. Functional status declined overtime on all 3 scales; however, only the change in Total Health score was statistically significant. Total, General Health, and Responsiveness scores declined by >/=5 points in 20.0%, 17.1%, and 14.3% of children, respectively. Significant univariate predictors of change in at least 1 component of the functional status survey included race, guardianship, height z score, prescription of antiviral medications other than antiretrovirals, and illness at time of baseline evaluation. In multivariate models, adjusting for baseline score and biologic relationship of guardian completing survey, significant predictors of a decline in Total Health scores included non-white race and lower baseline height z score. The General Health score declined with lower baseline absolute CD4 count and lower baseline height z score. Finally, Responsiveness scores declined in children whose guardian was their biologic parent and in children with lower baseline height z scores.
Conclusion:
The FSII(R) questionnaire correlates with other markers of disease severity in children with HIV infection. Growth parameters, immune status, and social factors are important predictors of functional status in HIV-infected children.
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