924
Improvements in the Clinical Status of HIV-infected Children; a Longitudinal Assessment of the Effects of Advances in Care
K Dominguez*1, E Handelsman2, M Paul3, T Sukalac1, M G Fowler1, I Ortiz4, H Hsu5, S Melville3, T Rakusan6, V Peters7, T Frederick8, PSD Consortium1, and PSD Consortium
1CDC, Atlanta, GA, USA; 2State Univ. of New York Downstate, Brooklyn, USA; 3Texas Dept. of Hlth., Austin, USA; 4Hlth. Dept., San Juan, PR, USA; 5Massachusetts State Labs., Jamaica Plain, MA, USA; 6Children's Natl. Med. Ctr., Washington, DC, USA; 7New York City Dept. of Hlth., NY, USA; and 8Los Angeles County Dept. of Hlth. Svcs., CA, USA
Background: The 1994 CDC HIV clinical classification (HCC) system classifies infected children into the
most severe clinical category ever experienced, including: not (N),
mildly (A), moderately (B), or severely (C) symptomatic. A child’s HCC can only become more severe or remain unchanged
over time and does not reflect recent clinical improvements in children
surviving from the pre-HAART era. The Pediatric Spectrum of HIV Disease (PSD) study monitors the HCC
of children in 6 U.S.
sites.
Methods: We adapted the CDC HCC system to classify children in PSD into their most severe category based only on
those conditions experienced in their most recent year of follow-up and
compared it with the most severe category experienced in their lifetime.
HIV-infected children born before 1996 who were followed actively through 1998
or later and had at least 12 consecutive months of follow-up between January 1, 1998
and December 31,
2001 were eligible for this analysis.
Results: The 1612 eligible children
had a median age of 11.4 years. More than 88.8% of children had ever been
reported as moderately or severely symptomatic compared with only
22.1% during their most recent year of follow-up. In addition, 78.0 % of
children were not symptomatic or mildly symptomatic during their last year of
follow-up, compared with 11.2% over their long-term follow-up.
|
|
No. (%) of children by most severe clinical
category of
HIV-related conditions experienced
|
Clinical Category
|
In lifetime
|
In most recent year of follow-up
|
|
N
= Not symptomatic
|
58 (3.6)
|
1102 (68.4)
|
|
A= Mildly symptomatic
|
122 (7.6)
|
154 (9.5)
|
|
B= Moderately symptomatic
|
995 (61.7)
|
316 (19.6)
|
|
C=
Severely symptomatic
|
437 (27.1)
|
40 (2.5)
|
|
Total
|
1612 (100.0)
|
100.(100.0)
|
Conclusions: Dramatically
fewer HIV-infected children surviving from the pre-HAART era were moderately or
severely symptomatic during their most recent year of follow-up. The CDC HCC
system remains useful in that it provides us with a historical marker of
severity of disease. However, adapting the HCC
to also include a classification based on last year of follow-up allowed us to
describe recent clinical improvements in the PSD
cohort. As HIV-infected children become teens, the PSD
cohort provides an invaluable resource in monitoring whether such hard-won gains
can be maintained or improved upon. These improvements underscore the need to
continue supporting the comprehensive services responsible for these dramatic
changes.
Keywords: Clinical Classification; Pediatric; Symptoms
