DISEASE PROGRESSION IN A COHORT OF INFANTS WITH VERTICALLY ACQUIRED HIV-INFECTION OBSERVED FROM BIRTH - THE WOMEN AND INFANTS TRANSMISSION STUDY (WITS)

Background: The Women and Infants Transmission Study is an ongoing pro spective cohort study of HIV-infected pregnant women and their infants . We used the 1994 U.S. Centers for Disease Control and Prevention (CD C) classification system for HIV infection in children to describe HIV disease progression in 128 HIV-infected children, and examined matern al and infant characteristics associated with disease course. Methods: The Kaplan-Meier method was used to calculate probabilities of entry into CDC clinical classes A, B, and C (mild, moderate, and severe HIV disease); CDC immunologic stages 2 and 3; and death. Relative risks of progression for selected predictor events were estimated using the Co x proportional hazards model. Results: With a median 24 months of foll ow-up, the median ages at entry into clinical classes A, B and C were 5, 11, and 48 months, respectively. Increased risk of progression to c lass C was seen in infants who had: onset of class B events (p < .001) ; progression to immunologic stage 2 (p < .001) or 3 (p < .001); early culture positivity tin first 48 hours, p < .01; in first 7 days, p = .03); and early appearance (within the first 3 months of life) of lymp hadenopathy, hepatomegaly, or splenomegaly (p < .001). Conclusions: Re aching specific clinical or immunologic stages were strong predictors of progression to AIDS or death. Early onset of clinical signs (onset of lymphadenopathy, hepatomegaly, or splenomegaly less than or equal t o 3 months of age), and early culture positivity (within the first 48 hours or within the first week of life); defined the infant with highe st risk of disease progression.