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Survival trends in adolescents with human immunodeficiency virus infection
1Department of Pediatrics, University of Minnesota Hospital and Clinics, Minneapolis, USA.
Objective:
To examine trends in survival and death in nonhemophiliac adolescents with human immunodeficiency virus (HIV) infection.
Design:
Case series.
Subjects:
All 117 HIV-seropositive adolescents (age range, 13 to 21 years) without hemophilia whose cases were reported through December 1992.
Setting:
A state with mandatory, name-linked reporting of cases of HIV.
Methods:
Review of death certificates and public records, and interviews with subjects and key informants.
Analyses:
Kaplan-Meier and Cox proportional hazards regression analyses of time from the diagnosis of HIV infection to death.
Results:
Documentation of death or survival was available for 92% (108/117) of the sample. Fourteen percent (15/108) of the subjects were known to have died, mainly of well-recognized complications of acquired immunodeficiency syndrome. Among deceased subjects, the median duration of survival after the diagnosis of HIV was 3 years. Cumulative survival at 8 years after the diagnosis was 52%, with 4 years being the median period of observation (range, < 1 year to 8 years). Stratification of survival functions by gender, race, and mode of transmission revealed no significant (P < .05) differences between groups. However, advancing age at the time of the diagnosis was inversely associated with survival.
Conclusions:
Despite an apparent advantage to young age, overall survival in this adolescent cohort was shorter than expected. Rather than an inherently rapid progression of disease during adolescence, delays in diagnosis and treatment might better explain the results.