PREDICTORS OF SURVIVAL IN CHILDREN WITH ACQUIRED-IMMUNODEFICIENCY-SYNDROME IN ITALY, 1983 TO 1995

To evaluate length and predictors of survival among children with AIDS , 529 pediatric cases diagnosed in Italy from 1983 to August 1995 were reviewed. Data were analyzed using Kaplan-Meier curves and the Cox pr oportional hazards regression model. Various survival patterns were su bsequently analyzed. All survival analyses were truncated on March 1, 1996. Cases were examined by gender, age at diagnosis, HIV transmissio n category, type and number of the first AIDS-defining diseases, level of immunosuppression at AIDS diagnosis, HIV transmission category of the mother, and period of diagnosis. The overall median survival time was approximately 24 months. There were no significant differences in survival by gender, HIV transmission category, mother's risk factor, o r period of diagnosis. The Kaplan-Meier analysis showed the greatest d ifferences in survival time between children less than 6 months of age at diagnosis (median survival 6.4 months) and all others (median 28.7 months). Children with recurrent bacterial infections or lymphoid int erstitial pneumonia (LIP) had a survival time at least four times long er than those with Pneumocystis carinii pneumonia (PCP), mycobacterios is, cytomegalovirus, humors, or progressive multifocal leukoencephalop athy. At the multivariate analysis, the risk of death was lower among children with LIP (Relative Hazard [RH] 0.72) compared with other oppo rtunistic diseases, whereas age less than 6 months, diagnosis of PCP o r of two or more diseases, and severe immunosuppression at diagnosis i ncreased the risk of death. Both demographic factors (age) and clinica l factors (type and number of initial diseases, level of immunosuppres sion) were found to be independent predictors of a poor prognosis in c hildren with AIDS. This information may be of use in improving prognos is and planning healthcare and treatment.