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Survival in children with perinatal HIV infection and very low CD4 lymphocyte counts

H W Hsu1, S Pelton, J M Williamson

  • 1University of Massachusetts Medical School, Jamaica Plain, Boston, Massachusetts, USA. howen.hsu@state.ma.us

Journal of Acquired Immune Deficiency Syndromes (1999)
|December 15, 2000
PubMed

Insights

Survival for children with HIV and low CD4 counts was variable. Factors like poor nutrition, cytomegalovirus (CMV) disease, and Mycobacterium avium intracellulare (MAI) infection were linked to shorter survival times in these pediatric HIV cases.

Area of Science:

  • Pediatric Infectious Diseases
  • Immunology
  • Public Health

Background:

  • Human Immunodeficiency Virus (HIV) infection in children significantly impacts immune function, particularly CD4+ T-lymphocyte counts.
  • Very low CD4+ counts (<100 cells/microliter) indicate severe immunosuppression and increased risk of opportunistic infections and mortality in pediatric HIV.
  • Understanding factors influencing survival in this vulnerable population is crucial for clinical management and public health strategies.

Purpose of the Study:

  • To identify clinical conditions and factors associated with mortality in children infected with HIV who have severely compromised immune systems (CD4+ counts <100 cells/microliter).
  • To analyze survival outcomes in pediatric HIV patients with very low CD4+ counts prior to the widespread availability of highly active antiretroviral therapy (HAART).

Main Methods:

  • A longitudinal medical record review was conducted through the Pediatric Spectrum of HIV Disease Project, involving eight US study sites.
  • Survival time from the first recorded very low CD4+ count (<100 cells/microliter) to death was analyzed using the Kaplan-Meier method.
  • Cox proportional hazards models were employed to determine the independent effect of various clinical variables on mortality risk.

Main Results:

  • The study included 522 children aged one year or older with serial CD4+ measurements.
  • Median survival after reaching a CD4+ count below 100 cells/microliter was 36 months.
  • Factors independently associated with increased mortality risk included younger age, significant underweight (weight-for-age >2 standard deviations below mean), and a prior AIDS diagnosis. Subsequent development of cytomegalovirus (CMV)-associated disease, Mycobacterium avium intracellulare (MAI) infection, wasting syndrome, or esophageal candidiasis also significantly increased mortality risk.

Conclusions:

  • Survival rates for HIV-infected children with very low CD4+ counts before the era of HAART were highly variable.
  • Poor nutritional status, cytomegalovirus (CMV) disease, and Mycobacterium avium intracellulare (MAI) infection were identified as key factors associated with the shortest survival times in this cohort.
  • These findings underscore the importance of monitoring nutritional status and managing opportunistic infections in pediatric HIV management.
Abstract

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