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Multicenter Study
. 2011 Nov;53(10):1024-34.
doi: 10.1093/cid/cir641.

Mortality trends in the US Perinatal AIDS Collaborative Transmission Study (1986-2004)

Bill G Kapogiannis  1 , Minn M Soe, Steven R Nesheim, Elaine J Abrams, Rosalind J Carter, John Farley, Paul Palumbo, Linda J Koenig, Marc Bulterys
Affiliations
Multicenter Study

Mortality trends in the US Perinatal AIDS Collaborative Transmission Study (1986-2004)

Bill G Kapogiannis et al. Clin Infect Dis. 2011 Nov.

Abstract

Background: Highly active antiretroviral therapy (HAART) has improved human immunodeficiency virus (HIV)-associated morbidity and mortality. The bimodal mortality distribution in HIV-infected children makes it important to evaluate temporal effects of HAART among a birth cohort with long-term, prospective follow-up.

Methods: Perinatal AIDS Collaborative Transmission Study (PACTS)/PACTS-HIV Follow-up of Perinatally Exposed Children (HOPE) study was a Centers for Disease Control and Prevention-sponsored multicenter, prospective birth cohort study of HIV-exposed uninfected and infected infants from 1985 until 2004. Mortality was evaluated for the no/monotherapy, mono-/dual-therapy, and HAART eras, that is, 1 January 1986 through 31 December 1990, from 1 January 1991 through 31 December 1996, and 1 January 1997 through 31 December 2004.

Results: Among 364 HIV-infected children, 56% were female and 69% black non-Hispanic. Of 98 deaths, 79 (81%) and 61 (62%) occurred in children ≤3 and ≤2 years old, respectively. The median age at death increased significantly across the eras (P < .0001). The average annual mortality rates were 18 (95% confidence interval [CI], 11.6-26.8), 6.9 (95% CI, 5.4-8.8), and 0.8 (95% CI, 0.4-1.5) events per 100 person-years for the no/monotherapy, mono-/dual-therapy and HAART eras, respectively. The corresponding 6-year survival rates for children born in these eras were 57%, 76%, and 91%, respectively (P < .0001). Among children who received HAART in the first 6 months of age, the probability of 6-year survival was 94%. Ten-year survival rates for HAART and non-HAART recipients were 94% and 45% (P < .05). HAART-associated reductions in mortality remained significant after adjustment for confounders (hazard ratio, 0.3; 95% CI, .08-.76). Opportunistic infections (OIs) caused 31.8%, 16.9%, and 9.1% of deaths across the respective eras (P = .051).

Conclusions: A significant decrease in annual mortality and a prolongation in survival were seen in this US perinatal cohort of HIV-infected children. Temporal decreases in OI-associated mortality resulted in relative proportional increases of non-OI-associated deaths.

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Figures

Figure 1.
Figure 1.
Mortality distribution by age group (A) and age at death (B) among enrollees in the Perinatal AIDS Collaborative Transmission Study (PACTS/PACTS–HOPE) (1986–2004). P < .0001 (trend test for median age at death). HAART, highly active antiretroviral therapy; max, maximum; min, minimum.
Figure 2.
Figure 2.
Annual mortality rate and antiretroviral use (A) and average annual declines in mortality rate (bold font) and 95% confidence intervals (CIs) (plain font) (B) in each therapeutic era among enrollees in the Perinatal AIDS Collaborative Transmission Study (PACTS/PACTS-HOPE) (1986–2004). ARV, antiretroviral; HAART, highly active antiretroviral therapy; NRTI, nucleoside/nucleotide reverse-transcriptase inhibitors; NNRTI, non-NRTI; PI, protease inhibitor.
Figure 3.
Figure 3.
Kaplan-Meier survival analysis among enrollees in the Perinatal AIDS Collaborative Transmission Study (PACTS/PACTS-HOPE) (1986–2004) by birth cohort (A) and age at initiation of highly active antiretroviral therapy (HAART) (B) (log-rank test, P < .05 for no HAART vs HAART initiation in different age groups considered separately and P < .01 for same comparison with combined age groups).
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Comment in

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