A POPULATION-BASED COMPARISON OF THE CLINICAL COURSE OF CHILDREN AND ADULTS WITH AIDS

Objective: To examine the association of clinical complications and ag e at diagnosis with survival for a cohort of children and adults with AIDS. Design: A population-based analysis of 734 children and 5584 adu lts diagnosed with AIDS from 1985 to 1990 in New York State. Results: The initial AIDS-defining diagnoses for 68% of children were lymphoid interstitial pneumonitis or infections specified in the Centers for Di sease Control and Prevention's (CDC) pediatric AIDS case definition bu t not the CDC's 1987 adult AIDS case definition. Of opportunistic infe ctions in both case definitions, Pneumocystis carinii pneumonia (PCP) was the most common initial AIDS diagnosis, occurring in 53% of adults , 47% of children aged <6 months at diagnosis (n=122) and 14% aged gre ater than or equal to 6 months at diagnosis (n=612). Median survival a fter AIDS diagnosis was 62 months for all children compared with 11 mo nths for adults. For children initially diagnosed with conditions only in the pediatric case definition, median survival ranged from 27 to 6 2 months compared with less than 12 months for children and adults wit h PCP. Compared with children aged 6-54 months, the estimated hazards of death for younger and older children were 2.06 [95% confidence inte rval (CI), 1.48-2.86] and 1.54 (95% CI, 1.10-2.16), respectively. Conc lusion: Children survived significantly longer than adults after AIDS diagnosis, but their survival varied by age at diagnosis. Differences in the types of common initial AIDS-defining diagnoses appear to contr ibute to the observed differences in survival.