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15 July 2006

Volume 43, Number 2
Clinical Infectious Diseases 2006;43:243–252
© 2006 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2006/4302-0018$15.00
DOI: 10.1086/505213
HIV/AIDS MAJOR ARTICLE

Clinical Outcomes Improve with Highly Active Antiretroviral Therapy in Vertically HIV Type‐1–Infected Children

Salvador Resino,1

Rosa Resino,1

José Mª Bellón,1

Dariela Micheloud,1

Mª Dolores Gurbindo Gutiérrez,2

Mª Isabel de José,3

José Tomás Ramos,4

Pablo Martín Fontelos,5

Luis Ciria,6 and

Mª Ángeles Muñoz‐Fernández,1 on behalf of the

Spanish Group of Pediatric HIV Infectiona

1Laboratorio de Inmuno‐Biología Molecular, 2Inmuno‐Pediatría, Hospital General Universitario “Gregorio Marañón,” 3Inmuno‐Pediatría, Hospital Universitario “La Paz,” 4Inmuno‐Pediatría, Hospital Universitario “12 de Octubre,” 5Pediatría‐Infecciosas, Hospital Universitario “Carlos III,” and 6Pediatría‐Infecciosas, Hospital Universitario “Niño Jesús,” Madrid, Spain

Background.Use of antiretroviral therapy has resulted in a decrease in morbidity and mortality rates in human immunodeficiency virus type 1 (HIV‐1)–infected children.

Methods.We performed a retrospective study involving 427 children to determine the effectiveness of different antiretroviral therapy protocols on clinical outcome. The follow‐up period was divided into 5 calendar periods (CPs): CP1 (1980–1989), before antiretroviral therapy was administered; CP2 (1990–1993), when monotherapy was administered; CP3 (1994–1996), when combined therapy was administered; CP4 (1997–1998), when 50% of children were receiving highly active antiretroviral therapy (HAART); and CP5 (1999–2003), when 60% of children were receiving HAART.

Results.Children experienced a progressive increase in the CD4+ cell count and decrease in the viral load from 1997 onwards. A lower number of AIDS cases and deaths occurred during CP5 than during the other CPs ( ), with a relative risk of an absence of AIDS of >20 and a relative risk of survival of >30. The AIDS rate was >50% in CP1; we observed a very strong decrease to 14% in CP2, to 16% in CP3, to 7% in CP4, and to 2% in CP5. The mortality rates in CP2 and CP3 were >6% and thereafter decreased to 0.5% in CP5. The relative risks for no hospital admission in CP4 and CP5 were >3.5. The total rates of hospital admission in CP1, CP2, and CP3 were >30%; we observed a decrease in CP4 and CP5. The duration of hospitalization decreased during the follow‐up period, and it was higher in CP1 (30 days) than in the other periods.

Conclusions.We observed that HAART produces a decrease in adverse clinical outcomes (i.e., hospital admission, AIDS, and death) in children with vertical HIV‐1 infection in Madrid, Spain.

Received 9 January 2006; accepted 28 March 2006; electronically published 9 June 2006.

Reprints or correspondence: Dr. Salvador Resino, Laboratorio de Inmuno‐Biología Molecular, Hospital General Universitario “Gregorio Marañón,” C/ Doctor Esquerdo 46, 28007, Madrid, Spain ().

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