NATURAL-HISTORY OF VERTICALLY ACQUIRED HUMAN IMMUNODEFICIENCY VIRUS-1INFECTION

Objective. To describe the natural history of vertically acquired huma n immunodeficiency virus (HIV) infection. Design. This was a prospecti ve follow-up study. Setting. Ten centers of the European Collaborative Study participated. Subjects. One hundred twenty-four HIV-infected ch ildren were born to women known to be infected at or before the time o f delivery since 1986. Main outcome measures. Deaths, acquired immunod eficiency syndrome (AIDS), and HIV-related symptoms and signs were ass essed. Results. In this cohort, treatment before the onset of AIDS was not universal. Less than 10% of children were treated with Zidovudine or intravenous gamma globulin before 6 months of age, with a steady i ncrease to about 40% after 3 years of life. An estimated 23% (95% conf idence interval: 15% to 31%) of infected children develop AIDS before the age of 1 year, and nearly 40% (27% to 50%) by 4 years. Ten percent (5% to 16%) die before age 1 year and 28% (16% to 41%) before age 5 y ears. Twenty-four months after the AIDS diagnosis, an estimated 48% (3 6% to 70%) of the children are still alive. Although after the age of 1 year immunologic abnormalities became increasingly common, the propo rtion of infected children with significant HIV-related symptoms or si gns declined. Conclusion. The progression of disease in this cohort of vertically infected children was not as fast as previously suggested, even though treatment was not widespread. Although infected children have a high risk of developing some manifestation of HIV infection ear ly in life, serious HIV-related symptoms became less frequent with inc reasing age. This has important implications for health planning and c are provision.