Clinical manifestations and survival of children with perinatal HIV-infection in Northeast Thailand

Abstract

Background: The number of Thai children with perinatal HIV-infection receiving antiretroviral therapy has been increasing. Objectives: To describe clinical manifestations and survival of children with perinatal HIV infection. Methods: All children with perinatal HIV infection who received care at a university hospital in Northeast Thailand between January 1998 and December 2006 were included in this study. Children were assessed for their outcomes through December 31, 2007. Results: There were 322 perinatally HIV-infected children, 55.3% were female. The median age at the first clinical event was 51 months (interquartile range (IQR) =13-82). The three most common initial clinical events were pruritic papular eruption, recurrent or chronic respiratory tract infection, and persistent diarrhea. The three most common opportunistic infections were pulmonary tuberculosis, oral candidiasis, and pneumonia. Two hundred and forty three (75.5%) children received antiretroviral therapy (ARV). The initial ARV was monotherapy in 12 children (4.9%), dual therapy in 71 (29.2%), and a highly active antiretroviral therapy (HAART) regimen in 157 (64.6%). ARV was started at the median age of 76 months (IQR=47-99). As of December 31, 2007, 236 children were alive and 54 (16.8%) were known to have died. The one- and 5-year survival rates of all children were 99.4% (95%CI= 97.5-99.8%) and 93.9% (95%CI=90.6-96.0%), respectively. In children who presented with CDC clinical class C, the one-and 5-year survival rates were 96.0% (95%CI=84.9%-98.9%) and 75.7% (95%CI=60.4-85.8%), respectively. Conclusion: Survival rates among perinatally HIV-infected children in Northeast Thailand, including those who developed AIDS, increased. This might be due to the availability of ARV treatment and holistic care.