Decline in Mortality, AIDS, and Hospital Admissions in Perinatally HIV-1 Infected Children in the United Kingdom and Ireland

The current study investigated changes over time in demographic factors, mortality, morbidity, hospital admission rates, and antiretroviral therapy in perinatally HIV-1-infected children in the United Kingdom and Ireland.

Since 1996, rates of death, morbidity and hospital admission have fallen among adults with HIV due to the introduction of three- or four-drug antiretroviral therapy. Treatment for children lagged behind because of challenges involved in developing appropriate formulations and the lack of age-specific pharmacokinetic data to guide pediatric dosing. Three- or four-drug regimens for children were introduced in mid-1997 and are now standard, according to the study.

The researchers used active surveillance through NSHPC and additional data through a subset of children in CHIPS to analyze 944 cases of perinatally acquired HIV reported in the UK and Ireland by October 2002.

Half of the 944 children were girls and 628 (67 percent) were black African. Twenty-two percent of the children (205) were aged =10 years at last follow up, and 193 (20 percent) are known to have died.

The researchers found that the proportion of HIV-infected children who were born abroad increased from 20 percent in 1994-95 to 60 percent during 2000-02. Mortality was stable before 1997 at 9.3 per 100 child years at risk but declined to 2.0 by 2001-02, an 80 percent decrease. "Most reductions occurred in 1997-99;" the investigators wrote, "rates stabilized between 2000 and 2002."

AIDS progression and hospital admission rates also substantially decreased, the study found, and the proportion of children on three- or four-drug therapy increased from 1997 on. However, "despite the 80 percent decrease in hospital admission rates, the absolute number of admissions decreased by only 25 percent; the increasing number of HIV infected children requiring care has implications for service requirements for HIV infected children and adolescents in the United Kingdom and Ireland," the investigators wrote.

"Rates of death, progression to AIDS and hospital admission in children with HIV in the United Kingdom and Ireland have significantly fallen," the study concluded. "As antenatal detection rates improve and fewer children born to infected women are themselves infected, children presenting to pediatric services with HIV are likely to be older and to have been born abroad. This, combined with improved life expectancy, means that the demand for specialist pediatric HIV services will continue to increase. Transitional links with adult services are required to deal with the medical, social and psychological needs of children entering adolescent and adult life."

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