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A descriptive study of HIV-infected long-term surviving children in Barbados--a preliminary report
A Kumar1, M A St John, D Lewis
1Department of Paediatrics, Queen Elizabeth Hospital and School of Clinical Medicine and Research, The University of the West Indies, Cave Hill, Barbados. bhavna@sunbeach.net
Insights
In pediatric HIV infection before effective treatment, about one-third of children survived past eight years. These long-term survivors often showed slow disease progression, with many maintaining good immune function.
Area of Science:
- Pediatric Infectious Diseases
- Immunology
- Clinical Pediatrics
Background:
- Human Immunodeficiency Virus type-1 (HIV-1) infection in children poses significant long-term health challenges.
- Understanding the natural history of pediatric HIV-1 is crucial for managing infected individuals, especially before widespread antiretroviral therapy (ART).
- Identifying factors associated with long-term survival in HIV-1 infected children provides insights into disease progression and potential therapeutic targets.
Purpose of the Study:
- To characterize the clinical and immunological profiles of HIV-1 infected children who survived beyond eight years of age in the pre-ART era.
- To identify patterns of disease progression and immune status among long-term survivors of pediatric HIV-1 infection.
Main Methods:
- Prospective cohort study of HIV-1 exposed and infected children born to HIV-1 positive mothers in Barbados (1986-1995).
- Enrollment occurred at birth or postnatal diagnosis of HIV exposure, with regular follow-up intervals.
- Analysis focused on children surviving to eight years and beyond, assessing clinical symptoms and CD4+ T-cell counts.
Main Results:
- Out of 44 HIV-1 infected children, 17 (38.6%) were classified as long-term survivors (>8 years).
- At eight years, 17.6% of these children were asymptomatic, and 52.9% had no significant immunodeficiency (CD4 counts >500 cells/µL).
- Among 16 long-term survivors followed post-eight years, 37.5% were categorized as long-term non-progressors with mild symptoms and preserved immune function.
Conclusions:
- In the absence of ART, approximately one-third of HIV-1 infected children survived beyond eight years.
- A significant proportion of these long-term survivors exhibited a slow disease progression rate, indicating variability in HIV-1 pathogenesis.
- These findings highlight the existence of a subgroup of children with favorable long-term outcomes in pediatric HIV-1 infection, even without modern therapies.
Objectives:
To describe the clinical and immunologic characteristics of human immunodeficiency virus type-1 (HIV-1)-infected children surviving to more than eight-years of age (long-survivors) before the introduction of antiretroviral therapy.
Methods:
This report is based on all the long-term survivors from a prospective cohort of HIV-infected children born to HIV-positive women in Barbados during 1986-1995. Infants born to HIV-infected women were enrolled into this cohort at birth or at the time of diagnosis of HIV exposure in the postnatal period and followed-up at regular intervals.
Results:
From a cohort of 44 HIV-infected children, 17 (38.6%) children survived to the age of eight years and beyond and were classified as long-term survivors. Median age of the sixteen long-term surviving children alive at the time of this report was 12 years (age range 8 - 16.7 years). At the age of 8 years, 17.6% of these children remained asymptomatic. Nine (52.9%) children had no immunodeficiency (CD4 counts >500 cells x 10(6)/L). Of the 16 long-term surviving children who were alive and had a median follow-up of 4.1 years (range 0.1 year to 8.5 years) after their eighth birthday, 37.5% had a CD4 cell count greater than 500 cells x 10(6)/L and had either no symptoms or only mild symptoms of HIV infection and were therefore categorized as the long-term non-progressors.
Conclusions:
In a small cohort of HIV-infected children, in the absence of antiretroviral therapy, only about one-third survived beyond eight years of age. On further follow-up of these long-term surviving children, over one-third had a slow rate of disease progression.
