SURVIVAL TRENDS IN ADOLESCENTS WITH HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION

Objective: To examine trends in survival and death in nonhemophiliac a dolescents with human immunodeficiency virus (HIV) infection. Design: Case series. Subjects: All 117 HIV-seropositive adolescents (age range , 13 to 21 years) without hemophilia whose cases were reported through December 1992. Setting: A state with mandatory, name-linked reporting of cases of HIV. Methods: Review of death certificates and public rec ords, and interviews with subjects and key informants. Analyses: Kapla n-Meier and Cox proportional hazards regression analyses of time from the diagnosis of HIV infection to death. Results: Documentation of dea th or survival was available for 92% (108/117) of the sample. Fourteen percent (15/108) of the subjects were known to have died, mainly of w ell-recognized complications of acquired immunodeficiency syndrome. Am ong deceased subjects, the median duration of survival after the diagn osis of HIV was 3 years. Cumulative survival at 8 years after the diag nosis was 52%, with 4 years being the median period of observation (ra nge, <1 year to 8 years). Stratification of survival functions by gend er, race, and mode of transmission revealed no significant (P<.05) dif ferences between groups. However, advancing age at the time of the dia gnosis was inversely associated with survival. Conclusions: Despite an apparent advantage to young age, overall survival in this adolescent cohort was shorter than expected. Rather than an inherently rapid prog ression of disease during adolescence, delays in diagnosis and treatme nt might better explain the results.