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Survival of children in Cape Town known to be vertically infected with HIV-1
G D Hussey1, R M Reijnhart, A M Sebens
1Department of Paediatrics and Child Health, University of Cape Town.
Insights
Survival patterns for vertically HIV-infected children in Cape Town show a median survival of 32 months. Early diagnosis and less severe disease significantly improve survival outcomes for pediatric HIV patients.
Area of Science:
- Pediatric Infectious Diseases
- Epidemiology
- Public Health
Background:
- Vertical transmission of Human Immunodeficiency Virus (HIV) poses a significant health challenge in pediatric populations.
- Understanding survival patterns is crucial for developing effective management strategies for vertically HIV-infected children.
Purpose of the Study:
- To investigate the survival patterns of children in Cape Town diagnosed with vertically acquired HIV infection.
- To identify factors influencing mortality risk in this pediatric cohort.
Main Methods:
- Retrospective record review of 193 vertically HIV-infected children diagnosed between 1990 and 1995.
- HIV diagnosis confirmed by ELISA and PCR; disease severity categorized using CDC criteria.
- Kaplan-Meier survival analysis and odds ratios calculated to assess mortality risk factors.
Main Results:
- Median survival was 32 months; 44% were alive at review, 34% had died, and 22% were lost to follow-up.
- Diagnosis at <6 months of age (OR 4.7) and severe CDC category C disease (OR 2.7) were significant predictors of mortality.
- Median survival for infants diagnosed <6 months was 10 months, compared to 36 months for those diagnosed at 7-12 months.
Conclusions:
- The median survival for vertically HIV-infected children in Cape Town was 32 months.
- Age at diagnosis and disease severity are critical determinants of survival in pediatric HIV.
- Timely diagnosis and intervention are essential for improving outcomes in children with vertically acquired HIV.
Objective:
To determine the survival patterns of children in Cape Town known to be vertically infected with HIV.
Design:
Retrospective record review of children diagnosed with symptomatic HIV infection during the period 1 December 1990-31 May 1995.
Setting:
Hospitals in the Cape Town metropolitan area.
Patients:
193 children were known to be vertically HIV-infected. HIV diagnosis was based on the following criteria: two positive HIV enzyme-linked immunosorbent assays (ELISAs) in children older than 15 months and a positive ELISA together with a positive polymerase chain reaction (PCR) in younger children. The mothers of the children were known to be HIV-positive. On the basis of the presenting clinical findings children were assigned to a disease severity category (A, B or C) according to the Centers for Disease Control and Prevention (CDC)'s 1994 revised classification system for HIV infection in children.
Outcome Measures:
Survival was analysed according to the Kaplan-Meier method. Survival time was defined as the length of time between clinical diagnosis of HIV and death or last contact with the health services. Mortality risk in relation to specific variables at diagnosis such as age and clinical manifestations was determined by calculation of odds ratios (ORs) with 95% confidence intervals (CIs).
Results:
The median age at diagnosis was 5 months; 72% of children were aged less than 1 year at diagnosis. According to the CDC clinical classification, 47 (24%) fell into category A, 111 (58%) into category B and 35 (18%) into category C. Of the 193 patients 85 (44%) were alive at the time of review, 65 (34%) had died and 43 (22%) were lost to follow-up. Risk of death was significantly associated with age less than 6 months (OR 4.7, CI 2.1-10.3) and severe disease, i.e. CDC category C (OR 2.7; CI 1.1-6.9) at time of diagnosis. The median survival for all the children from time of diagnosis was 32 months. Infants diagnosed before 6 months of age had significantly shorter median survival (10 months) compared with 36 months for those diagnosed at 7-12 months of age. For the children over the age of 12 months the cumulative proportion surviving at 48 months was 78%. Children with severe disease (category C) had a median survival of 21 months, significantly lower than that in category B (32 months). For the children in category A the cumulative proportion surviving at 48 months was 66%.
Conclusion:
The median survival of children with HIV was 32 months from time of diagnosis, and survival was influenced by age and disease severity.