Reduction in Mortality With Availability of Antiretroviral Therapy for Children With Perinatal HIV-1 Infection

摘要: ContextSince the introduction of combined antiretroviral therapy, mortality rates in adults with human immunodeficiency virus type 1 (HIV-1) infection have decreased. However, little information is available outside setting of controlled trials on survival perinatally HIV-infected children treated with therapy.ObjectiveTo assess effect availability therapy decreasing mortality children.DesignPopulation-based, multicenter longitudinal study involving data collected by Italian Register for HIV Infection Children.SettingA network 106 pediatric clinical centers.SubjectsA total 1142 born between November 1980 and December 1997 with acquired infection a median follow-up 5.9 years.Main Outcome MeasureTime to HIV-related death calculated birth cohort calendar period and grouped by distribution predominant therapy administered over time.ResultsSurvival was longer 1996-1997 (crude relative hazard [RH] death, 0.39; 95% confidence interval [CI], 0.15-0.96) 1996-1998 calendar period RH 0.65; CI, 0.45-0.95) than birth cohort 1980-1995, but not when adjusted maternal antiretroviral treatment during pregnancy condition at time delivery, gestational age, weight (adjusted 0.55; 0.20-1.50, for birth cohort; 0.71, 0.43-1.16, calendar period). In multivariate model 1980-1995 as comparison, 1996-1997 birth had an 0.57 (95% 0.22-1.47; P=.27) but 1996-1998 0.63 0.47-0.85; P<.01). When effects cohort, period, type of were evaluated simultaneously same model, the significantly different from 1.0 (P=.19) 1996-1998 (P=.83) suggesting causal relationship between decreased risk use combination therapy. The in children receiving monotherapy or double triple was 0.77 0.55-1.08), 0.70 0.42-1.17), 0.29 0.13-0.67), respectively, vs no therapy.ConclusionSurvival improved 1996-1998 as result therapies.