Aging cohort of perinatally human immunodeficiency virus-infected childrenin New York City

Background. New York City (NYC) pediatricians are now caring for fewer HIV- infected infants and more school age children and adolescents than earlier in the epidemic. Methods. Clinical, laboratory and demographic data were abstracted from med ical records at 10 NYC centers participating in the CDC Pediatric Spectrum of HIV Disease project. Pediatric AIDS cases and HIV-related deaths reporte d to the NYC Department of Health were examined. Results. Median age of HIV-infected children in care increased from 3 years in 1989 to 1991 to 6 years in 1995 to 1998. The number of HIV-infected wom en giving birth in NYC declined 50% from 1990 to 1997 (1630 to 831); increa sing numbers were identified prenatally (14% in 1989; 78% after 1995); and most received prenatal zidovudine prophylaxis (73% in 1997). Estimated peri natal transmission decreased to 10% by 1997, Improved identification of ser opositive status in infants was associated with an increased proportion of infected infants receiving Pneumocystis carinii pneumonia (PCP) prophylaxis , 84% in 1997, AIDS free survival was longer for children born 1995 to 1998 than for those born before 1995, P = 0.004. In 1998 among children with ad vanced immunosuppression (CDC category 3), 66% were prescribed 3 or more an tiretroviral medicines and 88% received PCP prophylaxis. Citywide AIDS case s and HIV-related deaths fell precipitously beginning in 1996. Conclusions, Based on the observations of this study, the cohort of NYC HIV -infected children in care is aging, associated with a decline in new HIV i nfections, high rates of PCP prophylaxis and increased time to AIDS. Fallin g HIV-related deaths citywide support these observations.