Natural history of vertically acquired human immunodeficiency virus-1 infection. The European Collaborative Study

Abstract

Objective: To describe the natural history of vertically acquired human immunodeficiency virus (HIV) infection.

Design: This was a prospective follow-up study.

Setting: Ten centers of the European Collaborative Study participated.

Subjects: One hundred twenty-four HIV-infected children were born to women known to be infected at or before the time of delivery since 1986.

Main outcome measures: Deaths, acquired immunodeficiency syndrome (AIDS), and HIV-related symptoms and signs were assessed.

Results: In this cohort, treatment before the onset of AIDS was not universal. Less than 10% of children were treated with Zidovudine or intravenous gamma globulin before 6 months of age, with a steady increase to about 40% after 3 years of life. An estimated 23% (95% confidence interval: 15% to 31%) of infected children develop AIDS before the age of 1 year, and nearly 40% (27% to 50%) by 4 years. Ten percent (5% to 16%) die before age 1 year and 28% (16% to 41%) before age 5 years. Twenty-four months after the AIDS diagnosis, an estimated 48% (36% to 70%) of the children are still alive. Although after the age of 1 year immunologic abnormalities became increasingly common, the proportion of infected children with significant HIV-related symptoms or signs declined.

Conclusion: The progression of disease in this cohort of vertically infected children was not as fast as previously suggested, even though treatment was not widespread. Although infected children have a high risk of developing some manifestation of HIV infection early in life, serious HIV-related symptoms became less frequent with increasing age. This has important implications for health planning and care provision.