CHANGES OVER TIME IN SURVIVAL OF CHILDREN AFTER AIDS DIAGNOSIS IN NEW-YORK-CITY

We determined whether survival of children following AIDS diagnosis is improving over time through 1991. AIDS surveillance data from New Yor k City Department of Health on 914 pediatric AIDS patients, diagnosed between 1979 and 1991 and presumed due to maternal-infant HIV transmis sion, were analyzed. Survival following AIDS diagnosis, established fr om hospital records and death certificates, was compared by calendar y ear of initial diagnosis using Kaplan-Meier lifetable analysis. Cox Pr oportional Hazards regression models were used to compare survival for patients diagnosed earlier or later in the decade, controlling for ag e at diagnosis, presenting opportunistic illness, and gender of the ch ild. Patients diagnosed with AIDS from October 1987 to September 1989 survived longer, median survival 17 months after diagnosis, than patie nts diagnosed before September 1987, median survival 10 months (relati ve risk [RR] = 0.76; 95% confidence intervals [CI] = 0.62, 0.93). Pati ents diagnosed from October 1989 to December 1991 also survived a medi an of 17 months. Secular improvements in survival after AIDS diagnosis remained after controlling for age at diagnosis, presenting diagnosis , and gender, even if deaths within three months of diagnosis were exc luded. These data suggest that for recent years, survival following AI DS diagnosis in those contracting the infection through maternal-infan t transmission has been prolonged. Possible explanations for these fin dings include both methodological issues (changes in diagnostic criter ia, incomplete ascertainment of deaths) and substantive issues (develo pments in therapeutic interventions and management of pediatric AIDS).