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Trends in mortality in the pre- and post-HAART eras among HIV-infected children in the U.S. Perinatal AIDS Collaborative Transmission Study (PACTS) (1986-2004)
Presented by Bill Kapogiannis, United States.
B. Kapogiannis1, M. Soe2, S. Nesheim2, E. Abrams3, J. Farley4, P. Palumbo5, L. Koenig2, M. Bulterys2
1National Institute of Child Health and Human Development, Pediatric, Adolescent and Maternal AIDS Branch, Bethesda, United States, 2Centers for Disease Control and Prevention, Atlanta, United States, 3Columbia University, Harlem Hospital, New York City, United States, 4University of Maryland, Baltimore, United States, 5Dartmouth College, Hanover, United States
Background: Highly active antiretroviral therapy (HAART) has improved AIDS-associated morbidity and mortality. Given the bimodal mortality distribution in HIV-infected children, it is important to evaluate temporal effects of HAART among a pure birth cohort with long-term, prospective follow-up.
Methods: PACTS was a CDC-sponsored multi-center, prospective birth cohort study of HIV-exposed infants enrolled 1986-1999 to monitor mother-to-child transmission and pediatric HIV progression. HIV-infected children were followed through 4/04. The average annual mortality was calculated for the no/mono-therapy, mono/dual-therapy and HAART eras, i.e. £12/31/90, 1/1/91-12/31/96, and ³1/1/97. Mortality trends were evaluated using survival analysis and Poisson regression. Extended proportional-hazards regression models were used to estimate the effect of HAART on mortality.
Results: Among 364 HIV-infected children, 55% were female and 69% black non-Hispanic. Of 98 deaths, 61(62%) and 79(81%) occurred in children £24 and £36 months old, respectively.
Advances in antiretroviral therapy led to commensurate improvements in crude annual mortality rates (P<0.05). Ten-year survival of those who ever received HAART and of non-HAART recipients was 94% and 45% (P<0.05).
[PACTS Mortality Figure ]
Using Poisson regression to adjust for gender, birth date, prematurity, era-entry age, PCP prophylaxis, maternal AIDS class and AZT prophylaxis, mortality rates in the no/mono- and mono/dual-therapy eras were >10-fold (P<0.01) and >3.5-fold (P<0.01) higher, respectively, than in the HAART era. HAART-associated declines in mortality remained significant after controlling for birth year, CD4% and anthropometrics (HR=0.3: 95%CI 0.11-0.82).
Conclusions: A significant decrease in annual mortality and a prolongation in survival were seen among HAART recipients in this U.S. perinatal cohort of HIV-infected children.
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