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Impact of highly active antiretroviral therapy on the morbidity and mortality in Spanish human immunodeficiency virus-infected children.

Abstract

BACKGROUND

Highly active antiretroviral therapy (HAART) slows the progression of HIV disease and lowers mortality and morbidity in adults. The impact on the disease course in children has not been still completely elucidated. Furthermore the effect of HAART on organ-specific complications of HIV is unknown.

OBJECTIVES

To assess the effect of HAART on the progression of HIV infection, mortality, organ-specific complications, number of infections and hospitalizations in HIV-1-infected children.

PATIENTS AND METHODS

Records of HIV-1-infected children were reviewed in a large referral pediatric hospital. Patients were divided into three groups: children who did not receive antiretroviral therapy (Group 1); children who received mono- or bitherapy (Group 2); and patients who received HAART (Group 3). Endpoints analyzed were progression to AIDS and mortality among AIDS patients and overall.

RESULTS

One hundred seven children have been evaluated. Actuarial survival at 5 years of age was 33% in Groups 1 and 2 compared with 100% in Group 3 (P < 0.01). At 5 years of age, the proportion of children progressing to AIDS was 76% in Groups 1 and 2, compared with 26% in Group 3 (P < 0.01). At 5 years of follow-up, there were 45 cases of organ-specific complications in patients without HAART. No children without organ-specific complications when HAART was started have developed them after 5 years (P < 0.01). In patients without HAART there were 9 cases of lymphoid interstitial pneumonia, and there was none in Group 3 (P < 0.01). The incidence rates of infections and hospitalizations were 2.83 and 0.52 per patient-year, respectively, in children who did not receive HAART and 0.75 and 0.17 when they were managed with HAART (relative risk, 0.26 and 0.32).

CONCLUSIONS

HAART is associated with a marked decline in the progression to AIDS, improved survival in HIV-1-infected children, reduced incidence of infections and hospitalizations and decreased incidence of some organ-specific complications of HIV.

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  • Authors+Show Affiliations

    ,

    Division of Immunodeficiencies, Hospital Universitario Doce de Octubre, Universidad Complutense, Madrid, Spain.

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    Source

    MeSH

    Acquired Immunodeficiency Syndrome
    Anti-HIV Agents
    Antiretroviral Therapy, Highly Active
    Cause of Death
    Child, Preschool
    Confidence Intervals
    Disease Progression
    Dose-Response Relationship, Drug
    Drug Administration Schedule
    Drug Therapy, Combination
    Female
    HIV Infections
    HIV-1
    Hospitalization
    Humans
    Infant
    Male
    Multivariate Analysis
    Odds Ratio
    Probability
    Reference Values
    Retrospective Studies
    Risk Assessment
    Severity of Illness Index
    Spain
    Survival Analysis
    Treatment Outcome

    Pub Type(s)

    Comparative Study
    Journal Article

    Language

    eng

    PubMed ID

    14551485

    Citation

    Sánchez, José Manuel, et al. "Impact of Highly Active Antiretroviral Therapy On the Morbidity and Mortality in Spanish Human Immunodeficiency Virus-infected Children." The Pediatric Infectious Disease Journal, vol. 22, no. 10, 2003, pp. 863-7.
    Sánchez JM, Ramos Amador JT, Fernández de Miguel S, et al. Impact of highly active antiretroviral therapy on the morbidity and mortality in Spanish human immunodeficiency virus-infected children. Pediatr Infect Dis J. 2003;22(10):863-7.
    Sánchez, J. M., Ramos Amador, J. T., Fernández de Miguel, S., González Tomée, M. I., Rojo Conejo, P., Ferrnado Vivas, P., ... Nogales Espert, A. (2003). Impact of highly active antiretroviral therapy on the morbidity and mortality in Spanish human immunodeficiency virus-infected children. The Pediatric Infectious Disease Journal, 22(10), pp. 863-7.
    Sánchez JM, et al. Impact of Highly Active Antiretroviral Therapy On the Morbidity and Mortality in Spanish Human Immunodeficiency Virus-infected Children. Pediatr Infect Dis J. 2003;22(10):863-7. PubMed PMID: 14551485.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Impact of highly active antiretroviral therapy on the morbidity and mortality in Spanish human immunodeficiency virus-infected children. AU - Sánchez,José Manuel, AU - Ramos Amador,José Tomás, AU - Fernández de Miguel,Sira, AU - González Tomée,María Isabel, AU - Rojo Conejo,Pablo, AU - Ferrnado Vivas,Paloma, AU - Clemente Vivas,Julián, AU - Ruiz Contreras,Jesús, AU - Nogales Espert,Angel, PY - 2003/10/11/pubmed PY - 2003/12/10/medline PY - 2003/10/11/entrez SP - 863 EP - 7 JF - The Pediatric infectious disease journal JO - Pediatr. Infect. Dis. J. VL - 22 IS - 10 N2 - BACKGROUND: Highly active antiretroviral therapy (HAART) slows the progression of HIV disease and lowers mortality and morbidity in adults. The impact on the disease course in children has not been still completely elucidated. Furthermore the effect of HAART on organ-specific complications of HIV is unknown. OBJECTIVES: To assess the effect of HAART on the progression of HIV infection, mortality, organ-specific complications, number of infections and hospitalizations in HIV-1-infected children. PATIENTS AND METHODS: Records of HIV-1-infected children were reviewed in a large referral pediatric hospital. Patients were divided into three groups: children who did not receive antiretroviral therapy (Group 1); children who received mono- or bitherapy (Group 2); and patients who received HAART (Group 3). Endpoints analyzed were progression to AIDS and mortality among AIDS patients and overall. RESULTS: One hundred seven children have been evaluated. Actuarial survival at 5 years of age was 33% in Groups 1 and 2 compared with 100% in Group 3 (P < 0.01). At 5 years of age, the proportion of children progressing to AIDS was 76% in Groups 1 and 2, compared with 26% in Group 3 (P < 0.01). At 5 years of follow-up, there were 45 cases of organ-specific complications in patients without HAART. No children without organ-specific complications when HAART was started have developed them after 5 years (P < 0.01). In patients without HAART there were 9 cases of lymphoid interstitial pneumonia, and there was none in Group 3 (P < 0.01). The incidence rates of infections and hospitalizations were 2.83 and 0.52 per patient-year, respectively, in children who did not receive HAART and 0.75 and 0.17 when they were managed with HAART (relative risk, 0.26 and 0.32). CONCLUSIONS: HAART is associated with a marked decline in the progression to AIDS, improved survival in HIV-1-infected children, reduced incidence of infections and hospitalizations and decreased incidence of some organ-specific complications of HIV. SN - 0891-3668 UR - https://www.unboundmedicine.com/medline/citation/14551485/Impact_of_highly_active_antiretroviral_therapy_on_the_morbidity_and_mortality_in_Spanish_human_immunodeficiency_virus_infected_children_ L2 - http://Insights.ovid.com/pubmed?pmid=14551485 DB - PRIME DP - Unbound Medicine ER -