Report of a Consensus Workshop, Siena, Italy, June 4???6, 1993 Markers and Determinants of Disease Progression in Children with HIV Infection

Abstract

It is widely acknowledged that the course of HIV infection is accelerated in infants and children compared with adults. Whereas ≥80% of untreated perinatally infected children will have symptoms of HIV infection by 18–24 months of age, the average duration of clinical latency in adults is 8–10 years (Table 1). Different patterns of disease expression have been found in HIV-infected children. Some have an accelerated disease course, developing manifestations of AIDS within the first year of life and dying earlier than other children. Others develop AIDS-related symptoms at a somewhat slower pace during the first several years of life, and a small number become symptomatic during their early teens. Understanding the factors that contribute to these different patterns of disease expression could have important implications for understanding the immunopathogenesis of HIV infection in infants and children and for defining guidelines for optimal monitoring and intervention. In recent years, investigators have attempted to delineate the clinical and laboratory features that serve as prognostic indicators of disease progression in HIV-infected infants and children. Disease progression changes over time, as therapeutic or prophylactic interventions are improved or made available earlier in the course of a patient's illness. Furthermore, investigators around the world have used different criteria to define the symptoms or disease manifestations associated with “symptomatic HIV infection” or disease progression. It is important, therefore, to reanalyze the validity of prognostic factors over time. For example, the clinical prognostic markers may be consequences of direct HIV infection or indirect complications resulting from HIV-induced immunosuppression. These prognostic markers should be defined as independent or dependent and must be assessed in univariate and multifactorial analyses of disease progression.