ABSTRACT
BACKGROUND: Effective therapies have increased life expectancy of human immunodeficiency virus (HIV)-infected pediatric patients. We investigated the underlying causes of death, mortality, and acquired immune deficiency syndrome (AIDS) rates in HIV-infected pediatric patients in Madrid, Spain. METHODS: We studied a multicenter cohort of 478 HIV-infected pediatric patients in Madrid. Mortality and AIDS incidence rates, causes of death, CD4 T-cell, and HIV RNA were analyzed during calendar periods (CPs): pre-HAART (highly active antiretroviral therapy) (CP1: 1982-1996) and post-HAART era (CP2: 1997-2009). RESULTS: During 5690 person-years of follow-up 157 (32.8%) deaths occurred. Median age at death increased (CP1: 3.2 years [1.0-6.3] vs. CP2: 7.7 years [3.1-11.4]; P < 0.01). Mortality and AIDS rates decreased 10.6-fold (95% confidence intervals [CI]: 6.9-16.7) and 6.9-fold (95% CI: 5.0-9.6), respectively, between CPs. Nevertheless, mortality was 10.4-fold (95% CI: 5.8-18.8; P < 0.001) higher than in age-similar general population in late-CP2. In all, 169 causes of death were reported. Multiple causes were reported in 16 of 151 (10.6%) patients. In 81.1% (137/169), the causes were AIDS-defining, 11.8% (20/169) HIV-related, and 7.1% (12/169) non-HIV-related. Infections were the leading causes (60.8%, 101/166); from 1999 to 2007 the risk of death from infections was 115.9 times (95% CI: 42.0-265.8; P < 0.001) higher than in the age-similar general population. Comorbidity was reported in 66.9% (101/151) of patients. Median HIV-1 RNA at death decreased (CP1: 5.9 [5.0-6.3]; CP2: 5.3 [4.2-5.8]; P < 0.01). CONCLUSIONS: Despite decline in mortality and AIDS rates, it is important to monitor all causes of death as prolonged survival might allow underlying comorbidity to become more clinically relevant.
Subject(s)
Cause of Death , HIV Infections/epidemiology , HIV Infections/mortality , Infectious Disease Transmission, Vertical , Adolescent , CD4 Lymphocyte Count , Child , Child, Preschool , Cohort Studies , Female , HIV Infections/transmission , HIV Infections/virology , HIV-1/isolation & purification , Humans , Incidence , Infant , Male , RNA, Viral/blood , Spain/epidemiology , Viral LoadABSTRACT
Fundamento y objetivo: Desde la publicación del estudio PACTG 076 en 1994 se han desarrollado medidas profilácticas frente a la transmisión vertical (TV) del virus de la inmunodeficiencia humana (VIH), principal vía de infección infantil por el VIH. Se comparan las características de las embarazadas infectadas por el VIH y las tasas de TV del VIH de 1994 y las de 2004. Pacientes y método: Se estudian las variables maternas, obstétricas y pediátricas de mujeres infectadas por el VIH y sus hijos, nacidos en 1994 y 2004 y seguidos en el Hospital La Paz. Resultados: Se incluye a 40 parejas madre-hijo de 1994 y 35 de 2004. La tasa de TV del VIH fue del 35% en 1994 y del 0% en 2004. No se observaron cambios en la TV del virus de la hepatitis (VHC). En 1994 las madres infectadas por el VIH estaban más sintomáticas y la vía de infección era el uso de drogas intravenosas, el parto vaginal era el más frecuente, y el tiempo de bolsa rota, más prolongado. En 2004 la vía de infección materna por el VIH fue principalmente sexual, se ha generalizado el tratamiento antirretroviral combinado en la mujer seropositiva, en la gestación, la cesárea programada era más frecuente y todos los neonatos recibieron zidovudina. Conclusiones: En una década se han producido importantes cambios epidemiológicos en las gestantes infectadas por el VIH en nuestro medio. La administración de antirretrovirales en el embarazo y al neonato y las medidas obstétricas preventivas pueden evitar la TV del VIH. No obstante, no se ha observado modificación en el riesgo de TV del VHC
Background and objective: Vertical transmission (VT) is the main route of human immunodeficiency virus (HIV) infection in children. Since the publication of PACTG 076 study in 1994, several preventive methods against the vertical transmission of the HIV have been developed. In this study, we compare the clinical and epidemiological profile of HIV-infected pregnant women and the VT rate in the years 1994 and 2004. Patients and method: We looked at maternal, obstetric and pediatric variables of HIV-infected women and their children, born in 1994 and 2004, who were followed in Hospital La Paz. Results: We included 40 mother-infant couples in 1994 and 35 couples in 2004. The HIV vertical transmission rate was 35% in 1994 and 0% in 2004. We did not find changes in Hepatitis C virus (HCV) vertical transmission. In 1994, HIV-infected mothers had a more advanced HIV-disease and the major route of HIV-transmission was the intravenous drug use. Vaginal delivery was more frequent and rupture of membranes was longer than in 2004. The main route of maternal HIV infection in 2004 was sexual contact. In this same year, the use of combination antiretroviral therapy, even during pregnancy, was generalized, the elective cesarean section was the most frequent form of delivery, and every newborn received zidovudine. Conclusions: In the last decade, there have been important epidemiological changes in HIV-infected mothers in our society. The administration of antiretroviral therapy during pregnancy and to the newborn, as well as other obstetric strategies, can prevent HIV vertical transmission. Nevertheless, we did not find any change in the risk of HCV vertical transmission
