Improving survival in children with AIDS in Brazil: results of the second national study, 1999-2002

Abstract

The objective of this study is to characterize survival in children with AIDS diagnosed in Brazil between 1999-2002, compared with the first national study (1983-1998). This national retrospective cohort study examined a representative sample of Brazilian children exposed to HIV from mother-to-child transmission and followed through 2007. The survival probability after 60 months was analyzed by sex, year of birth and death, clinical classification, use of antiretroviral therapy (ART) and prophylaxis for opportunistic diseases. 920 children were included. The survival probability increased: comparing cases diagnosed before 1988 with those diagnosed from 2001-2002 it increased by 3.5-fold (from 25% to 86.3%). Use of ART, initial clinical classification, and final classification were significant (p < 0.001) predictors of survival. Issues regarding quality of records and care were identified. The results point to the success of the Brazilian policy of providing ART. The improvement of clinical status contributes to quality of life, while indicating challenges, particularly practices to improve long-term care.

Opportunistic illnesses in Brazilian children with AIDS: results from two national cohort studies, 1983-2007

“…The present study has limitations beyond those already identified and described extensively in our previous publications on the topic [14-17]. Children in both cohorts had differing criteria for AIDS case definition, with greater sensitivity in the last one [6].…”

“…Thus, they had the chance to be treated with ARV, even in advanced stages of HIV infection [6,13,14]. …”

“…Both studies followed similar methodological procedures, as described in detail previously [14-17]. Children with HIV/AIDS were defined as those under 13 years of age, based on the national AIDS case definitions in children [6].…”

“…The status of children (dead or alive) was based on the follow-up until death or the end of 2002 [15,17]. The second study was composed of 945 children with AIDS diagnosed between January 1, 1999 and December 31, 2002, followed up until death or the end of 2007 [14,16]. …”

“…However, few children, especially those from highly vulnerable families still acquire HIV from their mothers and may develop AIDS. Two national cohort studies have shown an increased survival of these children with AIDS [14-17]. The probability of survival 60 months after diagnosis, which was 53% among those diagnosed with AIDS between 1983 and 1998, increased to 88% between 1999 and 2002 [14].…”