SURVIVAL OF CHILDREN IN CAPE-TOWN KNOWN TO BE VERTICALLY INFECTED WITH HIV-1

Objective. To determine the survival patterns of children in Cape Town known to be vertically infected with HIV. Design. Retrospective recor d review of children diagnosed with symptomatic HIV infection during t he period 1 December 1990 - 31 May 1995. Setting. Hospitals in the Cap e Town metropolitan area. Patients. 193 children were known to be vert ically HIV-infected. HIV diagnosis was based on the following criteria : two positive HIV enzyme-linked immunosorbent assays (ELISAs) in chil dren older than 16 months and a positive ELISA together with a positiv e polymerase chain reaction (PCR) in younger children. The mothers of the children were known to be HIV-positive, On the basis of the presen ting clinical findings children were assigned to a disease severity ca tegory (A, B or C) according to the Centers for Disease Control and Pr evention (CDC)'s 1994 revised classification system for HIV infection in children. Outcome measures. Survival was analysed according to the Kaplan-Meier method. Survival time was defined as the length of time b etween clinical diagnosis of HIV and death or last contact with the he alth services. Mortality risk in relation to specific variables at dia gnosis such as age and clinical manifestations was determined by calcu lation of odds ratios (ORs) with 95% confidence intervals (CIs). Resul ts. The median age at diagnosis was 5 months; 72% of children were age d less than 1 year at diagnosis. According to the CDC clinical classif ication, 47 (24%) fell into category A, 111 (58%) into category B and 35 (18%) into category C. Of the 193 patients 85 (44%) were alive at t he time of review, 65 (34%) had died and 43 (22%) were lost to follow- up. Risk of death was significantly associated with age less than 6 mo nths (OR 4.7, CI 2.1 - 10.3) and severe disease, i.e. CDC category C ( OR 2.7; CI 1.1 - 6.9) at time of diagnosis. The median survival for al l the children from time of diagnosis was 32 months. Infants diagnosed before 6 months of age had significantly shorter median survival (10 months) compared with 36 months for those diagnosed at 7 - 12 months o f age. For the children over the age of 12 months the cumulative propo rtion surviving at 48 months was 78%. Children with severe disease (ca tegory C) had a median survival of 21 months, significantly lower than that in category B (32 months). For the children in category A the cu mulative proportion surviving at 48 months was 66%. Conclusion. The me dian survival of children with HIV was 32 months from time of diagnosi s, and survival was influenced by age and disease severity.