Prognosis of HIV infection in children

• there have been reports of clearance of HIV in children with previously proven infection (1)
• a cohort study has investigated the clinical manifestations of disease progression (in children with HIV infection at birth) during the first 10 years of life (2)
  • cohort 1 - born during 1985 to 1988 when no treatment recommendation existed
  • cohort 2 - children born 1989 to 1994 when the treatment policy was restricted to monotherapy for symptomatic children
  • cohort 3 - children born 1995 to 1999 when the initiation of combination treatments were recommended at an early stage
  • Centers for Disease Control and Prevention categories for clinical manifestations were used (N=asymptomatic; A=mildly symptomatic; B=moderately severe symptoms, including lymphoid interstitial pneumonitis;C=severe symptoms; and D=death)
  • it was estimated that by 1 year of age
    • more than 25% of cohort 1 would have progressed to severe disease (category C)
    • 15% in cohort to would have progressed to severe disease
    • 5% in cohort 3
  • this cohort study reveals that a major improvement has occurred in the prognosis of children with HIV infection, especially in the first year of life. This change occurs following an increasing use of combination therapy and also an increasing use of Pneumocystis carinii pneumonia (PCP) prophylaxis

Reference:

1. McIntosh K, Burchett SK (1995). Clearance of HIV - lessons from newborns. NEJM, 332, 883-4.
2. The European Collaborative Study. Fluctuations in symptoms in human immunodeficiency virus-infected children; the first 10 years of life.Pediatrics 2001;108:116-22