DISEASE PATTERNS AND SURVIVAL AFTER ACQUIRED-IMMUNODEFICIENCY-SYNDROME DIAGNOSIS IN HUMAN IMMUNODEFICIENCY VIRUS-INFECTED CHILDREN

Background. The clinical manifestations of HIV infection in children i nvolve a broad spectrum of conditions ranging from mild symptoms to AI DS. Knowledge of the disease and survival patterns of these children a re needed to plan for future needs and develop baseline information to evaluate newer prophylactic or therapeutic management options. Object ives. To identify AIDS-defining conditions and estimate post-AIDS diag nosis survival among HIV-infected children. Methods. Disease patterns and survival after the diagnosis of AIDS-defining conditions were stud ied in 126 children who were identified through a multisite university -based active surveillance system in California from January, 1989, th rough August, 1993. Hospital medical records were periodically reviewe d and data were abstracted onto standardized forms designed for pediat ric HIV surveillance. We determined the length of survival between AID S diagnosis and death and evaluated the impact of disease patterns on survival using Kaplan-Meier's product-limit method and Cox proportiona l hazards regression. Results. The median age at diagnosis was 13 mont hs for children with perinatally acquired infection and 101.5 months f or children infected through other routes of transmission, Pneumocysti s carinii pneumonia and lymphoid interstitial pneumonia were the most common AIDS-defining conditions among perinatal cases, whereas the dis ease patterns observed among nonperinatal cases were more varied. The median postdiagnosis survival for the cohort was 26 months. Conclusion s. Survival time did not differ significantly by race/ethnicity, sex o r route of transmission. Respiratory candidiasis and wasting syndrome had significant negative impact on survival but P. carinii pneumonia w as not associated with shorter survival. Zidovudine or other antiviral therapies was associated with increased survival.