MORBIDITY AND MORTALITY IN EUROPEAN CHILDREN VERTICALLY INFECTED BY HIV-1 - THE FRENCH PEDIATRIC HIV-INFECTION STUDY-GROUP AND EUROPEAN COLLABORATIVE STUDY

Based on 392 infected children enrolled in two European prospective st udies of infants born to HIV-infected women, with similar standard pro tocols, HIV disease progression in the first 6 years of life is descri bed, using the 1994 CDC paediatric HIV classification. Most children h ad developed minor (A) or moderately severe (B) illness in the first 4 years of life, although usually it was transient in nature. Progressi on to U.S. Centers for Disease Control and Prevention (CDC) group C di sease or HIV-related death is an estimated 20% (95% confidence interva l 16-24%) during the first year of life, and 4.7% (3.3-65%) per year t hereafter, giving a cumulative incidence of 36% (30-43%) by 6 years. T he mortality rate at 6 years is 26% (20-32%). Two thirds of the childr en alive at 6 years had only minor symptoms, and one third had a CD4() cell distribution of >25% despite previous clinical manifestations a nd a transient period of moderate immune deficiency. Differences in zi dovudine monotherapy between the two cohorts were not associated with the mortality rate. However, the risk of severe bacterial infections w as lower in the French cohort, in which the use of antibacterial proph ylaxis was more common. The early, severe form of HIV disease affects similar to 20% of infants, and after 6 years 75% of infected children are still alive. This has important implications for health-care plann ing.