Reduction in Mortality With Availability of Antiretroviral Therapy for Children With Perinatal HIV-1 Infection

CONTEXT Since the introduction of combined antiretroviral therapy, mortality rates in adults with human immunodeficiency virus type 1 (HIV-1) infection have decreased. However, little information is available outside the setting of controlled trials on survival of perinatally HIV-infected children t...

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Published in:JAMA : the journal of the American Medical Association 2000-07, Vol.284 (2), p.190-197
Main Authors: de Martino, Maurizio, Tovo, Pier-Angelo, Balducci, Maria, Galli, Luisa, Gabiano, Clara, Rezza, Giovanni, Pezzotti, Patrizio, for the Italian Register for HIV Infection in Children and the Italian National AIDS Registry
Format: Article
Language:English
Subjects:
Antibiotics. Antiinfectious agents. Antiparasitic agents
antiretroviral therapy
Antiviral agents
Biological and medical sciences
Children & youth
Drug therapy
HIV
Human immunodeficiency virus
Human immunodeficiency virus 1
Human viral diseases
Infectious diseases
Medical sciences
Mortality
Pharmacology. Drug treatments
Viral diseases
Viral diseases of the lymphoid tissue and the blood. Aids
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Summary:CONTEXT Since the introduction of combined antiretroviral therapy, mortality rates in adults with human immunodeficiency virus type 1 (HIV-1) infection have decreased. However, little information is available outside the setting of controlled trials on survival of perinatally HIV-infected children treated with antiretroviral therapy. OBJECTIVE To assess effect of availability of antiretroviral therapy on decreasing mortality in perinatally HIV-infected children. DESIGN Population-based, multicenter longitudinal study involving data collected by the Italian Register for HIV Infection in Children. SETTING A network of 106 pediatric clinical centers. SUBJECTS A total of 1142 children born between November 1980 and December 1997 with perinatally acquired HIV infection with a median follow-up of 5.9 years. MAIN OUTCOME MEASURE Time to HIV-related death calculated for birth cohort and calendar period and grouped by distribution of predominant type of antiretroviral therapy administered over time. RESULTS Survival was longer in the 1996-1997 birth cohort (crude relative hazard [RH] of death, 0.39; 95% confidence interval [CI], 0.15-0.96) and 1996-1998 calendar period (crude RH of death, 0.65; 95% CI, 0.45-0.95) than in birth cohort and calendar period 1980-1995, but not when adjusted for maternal antiretroviral treatment during pregnancy and clinical condition at time of delivery, gestational age, and birth weight (adjusted RH of death, 0.55; 95% CI, 0.20-1.50, for birth cohort; and adjusted RH of death, 0.71, 95% CI, 0.43-1.16, for calendar period). In a multivariate model with 1980-1995 as comparison, the 1996-1997 birth cohort had an RH of 0.57 (95% CI, 0.22-1.47; P=.27) but RH for calendar period 1996-1998 was 0.63 (95% CI, 0.47-0.85; P
ISSN:0098-7484
1538-3598
DOI:10.1001/jama.284.2.190