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Development of a prognosis-based clinical staging system for infants infected with human immunodeficiency virus
B W Forsyth1, W A Andiman, T O'Connor
1Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut 06520-8064, USA.
Insights
A new clinical staging system for infants with human immunodeficiency virus (HIV) infection helps predict prognosis. This system, based on early childhood symptoms, significantly differentiates survival rates, aiding in care decisions.
Area of Science:
- Pediatrics
- Infectious Diseases
- Clinical Prognostics
Background:
- Infants with human immunodeficiency virus (HIV) infection require accurate prognostic tools.
- Early identification of disease progression is crucial for timely intervention.
Purpose of the Study:
- To develop a prognosis-based clinical staging system for infants diagnosed with HIV.
- To stratify HIV-infected infants into distinct clinical stages based on early-life findings.
Main Methods:
- Data were abstracted from medical records of 75 HIV-infected children.
- Relative risk (RR) for early mortality associated with each clinical finding determined stage assignment.
- Stages were defined based on increasing RR values, from Stage I (lowest risk) to Stage IV (highest risk).
Main Results:
- Stage IV included severe conditions like Pneumocystis carinii pneumonia and encephalopathy (RR > 3).
- Stage III encompassed conditions such as anemia, hepatitis, and serious bacterial infections (RR, 2-3).
- Stages II and I represented less severe conditions or asymptomatic presentation.
- Significant differences in survival curves were observed between stages when applied at 6 months of age (p < 0.0005 for IV vs III).
Conclusions:
- The developed clinical staging system offers valuable prognostic information for HIV-infected infants.
- This system can assist clinicians in advising parents about infant outcomes.
- It supports therapeutic decision-making and facilitates stratification for clinical trials in pediatric HIV research.
Purpose:
To develop a prognosis-based clinical staging system for infants infected with human immunodeficiency virus.
Methods:
Abstraction of data from medical records of 75 infected children. For each clinical finding present in infancy, the magnitude of the relative risk (RR) for early death was used to assign subjects to different clinical stages.
Results:
Stage IV (RR > 3) included subjects with Pneumocystis carinii pneumonia, other opportunistic infections, or encephalopathy. Stage III (RR, 2 to 3) included those with anemia, thrombocytopenia, hepatitis, fever, oral candidiasis, or one or more serious bacterial infections. Stage II included those with hepatomegaly, splenomegaly, failure to thrive, or persistent diarrhea, and stage I included those who had lymphadenopathy or were free of symptoms. When clinical staging was applied to the study population at ages as early as 6 months, survival curves were significantly different (IV vs III: p < 0.0005; III vs II + I: p < 0.005).
Conclusions:
Clinical staging should be beneficial in advising parents about an infant's prognosis, therapeutic decision making, and stratification for clinical trials.