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Multicenter Study
. 2009 Feb;163(2):164-71.
doi: 10.1001/archpedi.163.2.164.

Incidence of noninfectious conditions in perinatally HIV-infected children and adolescents in the HAART era

Sharon A Nachman  1 , Miriam Chernoff, Philimon Gona, Russell B Van Dyke, Wayne M Dankner, George R Seage 3rd, James Oleske, Paige L Williams; PACTG 219C Team
Collaborators, Affiliations
Multicenter Study

Incidence of noninfectious conditions in perinatally HIV-infected children and adolescents in the HAART era

Sharon A Nachman et al. Arch Pediatr Adolesc Med. 2009 Feb.

Erratum in

  • Arch Pediatr Adolesc Med. 2009 Apr;163(4):364

Abstract

Objective: To estimate highly active antiretroviral therapy (HAART)-era incident rates for the first episode of noninfectious conditions in human immunodeficiency virus (HIV)-infected youth in order to identify HAART-era changes in the natural history of perinatal HIV infection.

Design: Multicenter prospective cohort study.

Setting: More than 80 sites in the United States including Puerto Rico.

Patients: Perinatally HIV-infected youth.

Main outcome measures: Incidence rates (IRs) per 100 person-years were calculated for targeted noninfectious conditions occurring in perinatally HIV-infected children. A chi(2) test for linear trend was used to evaluate changes in the rates from 2001 to 2006.

Results: Two thousand five hundred seventy-five perinatally HIV-infected children (51%, female; 59%, black, non-Hispanic) were enrolled in Pediatric AIDS Clinical Trials Group (PACTG) 219C between 2000 and 2006 and were followed up for a median of 59 months. The 10 most common noninfectious conditions were pregnancy conditions (IR = 6.16; 95% confidence interval (CI), 3.9-9.3), birth defects (IR = 0.19; 95% CI, 0.1-0.3), gynecological dysplasias (IR = 5.92; 95% CI, 3.9-8.6), condyloma (IR = 0.15; 95% CI, 0.1-0.2), encephalopathy (IR = 0.38; 95% CI, 0.3-0.5), pancreatitis (IR = 0.30; 95% CI, 0.2-0.4), cardiac disorders (IR = 0.28; 95% CI, 0.2-0.4), renal disorders (IR = 0.26; 95% CI, 0.2-0.4), peripheral neuropathy (IR = 0.23; 95% CI, 0.2-0.4), and idiopathic thrombocytic purpura (IR = 0.15; 95% CI, 0.1-0.3). Among these conditions, 5 showed significant trends, with IRs increasing over time in pregnancy-related conditions (P < .001) and gynecological dysplasias (P = .02) while IRs decreased over time for encephalopathy (P < .001), pancreatitis (P = .002), and cardiac disorders (P = .007).

Conclusions: Between 2001 and 2006, the incidence for 3 conditions decreased and increased for 2 others, demonstrating the change in medical issues and conditions in perinatally infected youth. Continued surveillance with appropriate tools will be needed to assess the long-term effects of HAART and HIV as well as development of new noninfectious conditions of HIV.

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Figures

Figure 1
Figure 1
Incidence rates for noninfectious conditions, 2001 to 2006 (excludes gynecological cancers and dysplasias). Because of the difference in scale, we excluded the incidence for pregnancy conditions (6.2 per 100 person-years [PYs]; 95% confidence interval, 3.9–9.3) and gynecological cancers and dysplasias (5.9 per 100 PYs; 95% confidence interval, 3.9–8.6). ITP indicates idiopathic thrombocytic purpura.
Figure 2
Figure 2
A, Incidence rates for noninfectious conditions with decreases in incidence during 2001 to 2006 in perinatally human immunodeficiency virus (HIV)–infected children in Pediatric AIDS Clinical Trials Group (PACTG) protocol 219C. B, Incidence rates for pregnancy-related conditions during 2001 to 2006 for perinatally HIV-infected children in PACTG 219C. PY indicates person-year.
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