ObjectivesHighly active antiretroviral therapy (HAART) has dramatically changed the natural history of HIV infection in children, but there are few studies in the literature about the incidence of clinical manifestations after HAART in this population, compared with adults. The aim of this study was to describe the influence of the widespread use of HAART on the development of opportunistic infections and organ-specific diseases in HIV-infected children.
MethodsAn observational study of a cohort of 366 vertically HIV-infected children followed from 1990 to 2006 was carried out. According to the main antiretroviral protocol used, three calendar periods (CPs) were defined and compared: CP1 (1990CP1 ( -1996: no patients on HAART), CP2 (1997)(1998)(1999): o60% on HAART) and CP3 (2000)(2001)(2002)(2003)(2004)(2005)(2006): 460% on HAART).
ResultsChildren experienced a progressive increase in CD4 T cell count (Po0.05) and a decrease in HIV viral load from 1996 onwards (Po0.05). Similarly, rates of death, AIDS, opportunistic infections (bacteraemia, candidosis, cryptosporidiosis and bacterial pneumonia) and organ-specific diseases (wasting syndrome, thrombocytopenia, cardiomyopathy, lymphoid interstitial pneumonia and HIVassociated encephalopathy) were lower in CP2 and CP3 than in CP1.
ConclusionsThis study provides evidence of improved clinical outcomes in HIV-infected children over time and shows that mortality, AIDS, opportunistic infections and organ-specific diseases declined as HAART was progressively instituted in this population. There are some specific issues related to paediatric, as opposed to adult, HIV infection. For example, the number of available formulations is limited. There is also a scarcity of clinical trials in children, and insufficient data on the efficacy and toxicity of antiretrovirals for paediatric use, and on the long-term consequences of perinatally acquired HIV infection and drug toxicity. In the last few decades, outcomes for HIV-infected children and adolescents have improved dramatically with the widespread use of antiretrovirals, despite delayed introduction of their use in this population relative to the adult population. Data on changes in the incidence of OIs in the paediatric population with the widespread use of HAART are scarce as compared with the information available in adults [4,11]. To our knowledge, only two recent reports have estimated the incidence of OSDs during the HAART era [6,12].The aim of this study was to assess the influence of the widespread use of HAART on clinical outcomes, especially the development of OIs and OSDs, in perinatally HIVinfected children.
Methods
Design of the study and settingA multicentre observational study of a cohort of 366 vertically HIV-infected children was conducted from January 1990 to December 2006 at the eight main referral paediatric hospitals of Madrid. Data were retrospectively collected from clinical charts for 1990 to 2003. From January 2003 to December 2006 all data were recorded prospectively. Children were followed at least e...
