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Survival in children with perinatally acquired human immunodeficiency virus type 1 infection
G B Scott1, C Hutto, R W Makuch
1Department of Pediatrics, University of Miami School of Medicine, Fla. 33101.
Insights
Perinatally acquired human immunodeficiency virus type 1 (HIV-1) infection in children has a poor prognosis, with most symptomatic before age one. Early diagnosis is crucial for timely treatment before disease progression.
Area of Science:
- Pediatrics
- Infectious Diseases
- Virology
Background:
- Perinatally acquired human immunodeficiency virus type 1 (HIV-1) infection affects children, with mothers contracting HIV-1 through heterosexual contact, intravenous drug use, or blood transfusions.
- Most children with perinatally acquired HIV-1 present with symptomatic disease before the age of two years.
Purpose of the Study:
- To describe the clinical experience and survival outcomes of children diagnosed with perinatally acquired HIV-1 infection.
- To identify factors influencing survival in this pediatric population.
Main Methods:
- Retrospective analysis of 172 children diagnosed with perinatally acquired HIV-1 infection at Jackson Memorial Hospital.
- Evaluation of presenting symptoms, age at diagnosis, specific clinical manifestations, and survival times.
Main Results:
- The median age at presentation was eight months, with common initial symptoms including lymphoid interstitial pneumonia, encephalopathy, recurrent bacterial infections, and Candida esophagitis.
- Median survival for all children was 38 months; mortality was highest in the first year of life.
- Early age at diagnosis and specific clinical disease patterns were independently associated with survival.
Conclusions:
- Children with perinatally acquired HIV-1 infection have a poor prognosis and typically become symptomatic within the first year of life.
- Early diagnosis is critical for initiating prophylactic or antiviral therapies to improve outcomes before disease progression.
Abstract:
We describe our experience at Jackson Memorial Hospital in Miami, Florida, with 172 children who were given diagnoses of perinatally acquired infection with human immunodeficiency virus type 1 (HIV-1). The 146 mothers of the children acquired HIV-1 through heterosexual contact (69 percent), intravenous drug use (30 percent), or blood transfusion (1 percent). The children presented with symptomatic disease at a median age of eight months; only 21 percent presented after the age of two years. The most common first manifestations of disease were lymphoid interstitial pneumonia (in 17 percent), encephalopathy (in 12 percent), recurrent bacterial infections (in 10 percent), and candida esophagitis (in 8 percent), for which the median survival times from diagnosis were 72, 11, 50, and 12 months, respectively. Nine percent of the children had Pneumocystis carinii pneumonia at a median age of five months and had a median survival of only one month. The median survival for all 172 children was 38 months from the time of diagnosis. Mortality was highest in the first year of life (17 percent), and by proportional-hazard analysis the probability of long-term survival is low. In multivariate analyses, early age at diagnosis and the first identifiable pattern of clinical disease were found to be independently related to survival. We conclude that children with perinatally acquired HIV-1 infection have a very poor prognosis and that most become symptomatic before one year of age. Early diagnosis is important, since there is only a short interval in which to initiate prophylactic or antiviral treatment before progressive disease begins.