Abstract
The use of highly active antiretroviral therapy (HAART) for human immunodeficiency virus (HIV)-infected patients has reduced the number of acquired immune deficiency syndrome-related deaths worldwide. This study assessed the impact of HAART on the survival and death rates of vertically HIV-infected children and adolescents in Belo Horizonte, Brazil. Data were obtained from a historic cohort of vertically HIV-infected children and adolescents aged zero-19 years old who were admitted from March 1989-December 2004 and were followed until June 2006. Patients who used HAART were included if they were treated for at least 12 weeks. Of 359 patients, 320 patients met the inclusion criteria. The overall mortality rate was 9.7% [31/320; 95% confidence interval (CI): 6.0-13%]. The median survival for the non-HAART and HAART groups was 31.5 and 55.9 months, respectively (log rank = 22.11, p < 0.0001). In the multivariate analysis, the statistically significant variables were HAART and the weight-for-age Z score < -2, with HAART constituting a protective factor [relative risk (RR): 0.13; CI 95%: 0.05-0.33] and malnutrition constituting a risk factor (RR: 3.44; CI 95%: 1.60-7.40) for death. The incidence of death was 5.1/100 person-years in the non-HAART group and 0.8/100 person-years in the HAART group (p < 0.0001).
Highlights
The use of highly active antiretroviral therapy (HAART) for human immunodeficiency virus (HIV)-infected patients has reduced the number of acquired immune deficiency syndrome-related deaths worldwide
By the end of 2009, an estimated 33.3 [95% confidence interval (CI): 31.4-35.3] million people were living with human immunodeficiency virus (HIV) worldwide and 2.5 million of these were children
HIV mortality in children has decreased by 80-90% since the introduction of protease inhibitor (PI)-containing ARV regimens and opportunistic and other related infections have significantly decreased in HIV-infected children in the highly active antiretroviral therapy (HAART) era
Summary
The study included 320 HIV-infected children and adolescents admitted to the CTR-DIP from March 1989December 2004 and followed until June 2006. The HAART and non-HAART groups did not differ demographically by gender or age upon admission. Patients in the HAART group presented the lowest values for weight/age and height-for-age Z scores upon admission. The same trend was noticed in the laboratory parameters, with patients in the HAART group presenting lower CD4 counts and higher viral loads upon admission. Anthropometric variables weight-for-age and weightfor-height Z scores were statistically significant in the univariate analysis. The variables used for constructing the Cox proportional hazards model in the multivariate analysis were age range, weight-for-age Z score
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