Article

Declines in mortality rates and changes in causes of death in HIV-1-infected children during the HAART era

Nationwide Children's Hospital, Columbus, OH, USA. michael.Brady@nationalwidechildren's.org
JAIDS Journal of Acquired Immune Deficiency Syndromes (Impact Factor: 4.56). 01/2010; 53(1):86-94. DOI: 10.1097/QAI.0b013e3181b9869f
Source: PubMed

ABSTRACT

Introduction of highly active antiretroviral therapy has significantly decreased mortality in HIV-1-infected adults and children. Although an increase in non-HIV-related mortality has been noted in adults, data in children are limited.
To evaluate changes in causes and risk factors for death among HIV-1-infected children in Pediatric AIDS Clinical Trials Group 219/219C.
Multicenter, prospective cohort study designed to evaluate long-term outcomes in HIV-1-exposed and infected US children. There were 3553 HIV-1-infected children enrolled and followed up between April 1993 and December 2006, with primary cause of mortality identified in the 298 observed deaths.
Mortality rates per 100 child-years overall and by demographic factors; survival estimates by birth cohort; and hazard ratios for mortality by various demographic, health, and antiretroviral treatment factors were determined.
Among 3553 HIV-1-infected children followed up for a median of 5.3 years, 298 deaths occurred. Death rates significantly decreased between 1994 and 2000, from 7.2 to 0.8 per 100 person-years, and remained relatively stable through 2006. After adjustment for other covariates, increased risk of death was identified for those with low CD4 and AIDS-defining illness at entry. Decreased risks of mortality were identified for later birth cohorts, and for time-dependent initiation of highly active antiretroviral therapy (hazard ratio 0.54, P < 0.001). The most common causes of death were "End-stage AIDS" (N = 48, 16%) and pneumonia (N = 41, 14%). The proportion of deaths due to opportunistic infections (OIs) declined from 37% in 1994-1996 to 24% after 2000. All OI mortality declined during the study period. However, a greater decline was noted for deaths due to Mycobacterium avium complex and cryptosporidium. Deaths from "End-stage AIDS," sepsis and renal failure increased.
Overall death rates declined from 1993 to 2000 but have since stabilized at rates about 30 times higher than for the general US pediatric population. Deaths due to OIs have declined, but non-AIDS-defining infections and multiorgan failure remain major causes of mortality in HIV-1-infected children.

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Available from: Lynne M Mofenson, Aug 29, 2014
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    • "During the last twenty years, the development of antiretroviral drugs and the use of highly active antiretroviral therapy (HAART) have dramatically reduced mortality among patients infected with human immunodeficiency virus (HIV). The success of ART has led to HIV becoming a chronic disease123. Therefore, the period of medication of HIV infected patients has been prolonged, and adverse events and adherence have become more important. "
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    Full-text · Article · Dec 2015
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    • "Due to the scale up of antiretroviral therapy over the last decade, survival of perinatally-infected children has improved dramatically, enabling them to live into adolescence and beyond [5]. As they do so, the issue of informing adolescents about their HIV status arises, a process termed “status disclosure” [6]–[8]. "
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    • "By 2007, according to the CDC, 49% of PHIVA in the United States were over 15 years of age [59]. UNAIDS reports less than 100 deaths among HIV-infected children less than 15 years of age, but again, given the age distribution of the perinatally infected population, this likely represents less than half the number of deaths among the perinatally infected in the United States, especially since older individuals are at increased risk of death [1]. Nevertheless, given the low mortality and very low number of newly infected babies (<100 per year), the perinatally infected population in the United States is at a relatively stable number of over 10,000 individuals, most of whom are now young adults and with the oldest members now entering the fourth decade of life. "
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