Predictors of change in the functional status of children with human immunodeficiency virus infection

Objective. The purpose of this study was to identify important clinical pre dictors of change in the functional status of children with perinatally acq uired human immunodeficiency virus (HIV) infection. Methods. Children who were perinatally exposed to HIV underwent evaluation of growth, nutritional, and functional status parameters as part of a prosp ective study of HIV and nutrition in children. The main outcome measures fo r HIV-infected children were change over time in: 1) Total Health, 2) Gener al Health, and 3) Responsiveness as measured by the Functional Status II(R) (FSII[R]). Candidate predictors included anthropometric measurements, soci al factors, HIV disease stage, CD4 T lymphocyte count, medications, and oth er clinical markers of illness. Results. The parents or legal guardians of 35 perinatally HIV-infected chil dren completed 2 FSII( R) surveys over a mean of 16 months. Functional Stat us scores were significantly correlated with number of times and days hospi talized in the past 6 months and with illness at the time of baseline evalu ation. Functional status declined overtime on all 3 scales; however, only t he change in Total Health score was statistically significant. Total, Gener al Health, and Responsiveness scores declined by greater than or equal to 5 points in 20.0%, 17.1%, and 14.3% of children, respectively. Significant u nivariate predictors of change in at least 1 component of the functional st atus survey included race, guardianship, height z score, prescription of an tiviral medications other than antiretrovirals, and illness at time of base line evaluation. In multivariate models, adjusting for baseline score and b iologic relationship of guardian completing survey, significant predictors of a decline in Total Health scores included non-white race and lower basel ine height z score. The General Health score declined with lower baseline a bsolute CD4 count and lower baseline height z score. Finally, Responsivenes s scores declined in children whose guardian was their biologic parent and in children with lower baseline height z scores. Conclusion. The FSII(R) questionnaire correlates with other markers of dise ase severity in children with HIV infection. Growth parameters, immune stat us, and social factors are important predictors of functional status in HIV -infected children.