Temporal Trends in Early Clinical Manifestations of Perinatal HIV Infection in a Population-Based Cohort

Abstract

ORLDWIDE, APPROXImately 2.5 million children are infected with the human immunodeficiency virus (HIV), 1 and approximately 1700 new perinatal infections occur daily. 2 In the United States, more than 9300 HIV-infected children younger than 13 years have progressed to AIDS as of December 2003. 2 While the Pediatric AIDS Clinical Trials Group (PACTG) 076 regimen has reduced perinatal transmission by 67%, 3,4 prenatal combination antiretroviral therapy (ART) has further reduced transmission to 2% or less. 4,5 Moreover, earlier diagnosis and treatment has improved the prognosis of perinatal HIV infection. [6][7][8][9][10][11][12][13] However, the impact of treatment on progression of perinatal HIV infection remains poorly characterized at the population level.Perinatal HIV infection may progress in 2 patterns: early, with a median onset of age 4 months, or late, with a median onset of age 6 years. [14][15][16][17] It is esti-See also pp 2213 and 2272.

Outcomes for Human Immunodeficiency Virus-1-Infected Infants in the United Kingdom and Republic of Ireland in the Era of Effective Antiretroviral Therapy

“…Although numbers are small in this study, the only child among the 10 prospectively identified infants starting ART before 3 months who progressed to AIDS initiated ART at 90 days of age; in contrast, 45% of infants progressed who started ART after 3 months or did not receive ART at all. These findings are similar to those reported in French and U.S. cohorts, 17,19 although three infants in our study developed HIV encephalopathy despite early ART, in contrast to the French cohort study. However, both these studies and our own are observational and the children were not randomized.…”

Timing of Antiretroviral Therapy Initiation and its Impact on Disease Progression in Perinatal Human Immunodeficiency Virus-1 Infection

“…We found that HAART was associated with reduced and delayed clinical and immunologic progression regardless of disease stage at initiation. The effect of HAART in preventing progression to clinical category C and death in children younger than 3 years of age has been previously demonstrated by our study group 2 ; others have demonstrated HAART-related declines in morbidity and mortality for the treatment of perinatal HIV-1 infection 1, 24, 25 . In this study we demonstrated that a reduction in disease progression and mortality occurred regardless of the disease stage at HAART initiation.…”

Antiretroviral Treatment of US Children With Perinatally Acquired HIV Infection: Temporal Changes in Therapy Between 1991 and 2009 and Predictors of Immunologic and Virologic Outcomes

“…22 Likewise, among 205 infected children in a Northern California cohort born between 1988 and 2001, 40% had developed an AIDS diagnosis at a median of three years of age, compared to only 18% of those in our 1998–2002 birth cohort. 23 However, the children in our study were older at entry, and children with a prior AIDS-defining condition are less likely to survive to an older age.…”

“…A previous study found a similar rate of progression to AIDS (21%) among their latest birth cohort (1996–2001), which was significantly lower that of their earlier birth cohorts. 23 The lower median peak viral loads observed in our earlier birth cohorts are likely because viral load testing was not generally available until 2000, when these subjects were older and already receiving ART, as reflected in their age at peak viral load and age at starting ART.…”