Long-term follow-up of HIV-seropositive children

Of the 4720 children enrolled in the Italian Register, 4554 were born to se ropositive mothers. Of the latter, at the latest update 2989 (65.6%) had se roreverted, 440 (9.7%) were in indeterminate infection status, while 1125 ( 24.7%) were infected. Among these, 382 died of HIV-associated illnesses. Th e median age of those still alive was 82.5 months (range 1.4-192.8 months). The last survival curve highlighted an improvement in survival probability (51% at 130 months). The causes of death differed between infants and olde r children, with a higher proportion of Pneumocystis carinii pneumonia and cytomegalovirus (CMV) in the former. Only a fraction of infected children ( < 3%) become long-term non-progressors (LTNPs). Immunological and clinical deterioration may occur at any age and in any child, including LTNPs. A tar geted analysis revealed a poor prognostic indication of the clinical and im munological categories of the current CDC classification system for HIV inf ection in children. Both infected and uninfected exposed children are at hi gh risk of separation from their family due to either parents' death or dru g use. Given the high proportion of intravenous drug users among HIV-positi ve mothers, about three-quarters had hepatitis C virus (HCV) co-infection, and some of their children who escaped infection with HIV acquired HCV. An increasing proportion of HIV-infected children are approaching adolescence. This raises important new problems, such as when and how to communicate th e diagnosis to these children, who need adequate psychological support to f ace the impact of knowing they are carriers of such an infection.