BMJ  2003;327:1019 (1 November), doi:10.1136/bmj.327.7422.1019

Paper

Decline in mortality, AIDS, and hospital admissions in perinatally HIV-1 infected children in the United Kingdom and Ireland

¹ Medical Research Council Clinical Trials Unit, London NW1 2DA, ² Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, London WC1N 1EH, ³ Paediatric Infectious Diseases Unit, St George's Hospital, London SW17 0QT, ⁴ Department of Paediatrics, St Mary's Hospital, London W2 1NY, ⁵ Great Ormond Street Hospital for Sick Children NHS Trust, London WC1N 3JH, ⁶ Our Lady's Hospital for Sick Children, Crumlin, Dublin 12, Republic of Ireland, ⁷ Birmingham Heartlands Hospital, Bordesley Green East, Birmingham B9 5SS

Objective To describe changes in demographic factors, disease progression, hospital admissions, and use of antiretroviral therapy in children with HIV.

Design Active surveillance through the national study of HIV in pregnancy and childhood (NSHPC) and additional data from a subset of children in the collaborative HIV paediatric study (CHIPS).

Setting United Kingdom and Ireland.

Participants 944 children with perinatally acquired HIV-1 under clinical care.

Main outcome measures Changes over time in progression to AIDS and death, hospital admission rates, and use of antiretroviral therapy.

Results 944 children with perinatally acquired HIV were reported in the United Kingdom and Ireland by October 2002; 628 (67%) were black African, 205 (22%) were aged 10 years at last follow up, 193 (20%) are known to have died. The proportion of children presenting who were born abroad increased from 20% in 1994-5 to 60% during 2000-2. Mortality was stable before 1997 at 9.3 per 100 child years at risk but fell to 2.0 in 2001-2 (trend P < 0.001). Progression to AIDS also declined (P < 0.001). From 1997 onwards the proportion of children on three or four drug antiretroviral therapy increased. Hospital admission rates declined by 80%, but with more children in follow up the absolute number of admissions fell by only 26%.

Conclusion In children with HIV infection, mortality, AIDS, and hospital admission rates have declined substantially since the introduction of three or four drug antiretroviral therapy in 1997. As infected children in the United Kingdom and Ireland are living longer, there is an increasing need to address their medical, social, and psychological needs as they enter adolescence and adult life.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    StumbleUpon    Technorati    What's this?

This article has been cited by other articles:

• Riordan, A, Bugembe, T (2009). Update on antiretroviral therapy. Arch. Dis. Child. 94: 70-74 [Abstract] [Full text]  
• Rozenbaum, M H, Verweel, G, Folkerts, D K F, Dronkers, F, van den Hoek, J A R, Hartwig, N G, de Groot, R, Postma, M J (2008). Cost-effectiveness estimates for antenatal HIV testing in the Netherlands. Int J STD AIDS 19: 668-675 [Abstract] [Full text]  
• Oberdorfer, P., Louthrenoo, O., Puthanakit, T., Sirisanthana, V., Sirisanthana, T. (2008). Quality of Life Among HIV-Infected Children in Thailand. J Int Assoc Physicians AIDS Care (Chic Ill) 7: 141-147 [Abstract]  
• Foster, C., Lyall, H. (2008). HIV and mitochondrial toxicity in children. J Antimicrob Chemother 61: 8-12 [Abstract] [Full text]  
• Janssens, B., Raleigh, B., Soeung, S., Akao, K., Te, V., Gupta, J., Chhy Vun, M., Ford, N., Nouhin, J., Nerrienet, E. (2007). Effectiveness of Highly Active Antiretroviral Therapy in HIV-Positive Children: Evaluation at 12 Months in a Routine Program in Cambodia. Pediatrics 120: e1134-e1140 [Abstract] [Full text]  
• Kourtis, A. P., Bansil, P., Posner, S. F., Johnson, C., Jamieson, D. J. (2007). Trends in Hospitalizations of HIV-Infected Children and Adolescents in the United States: Analysis of Data From the 1994 2003 Nationwide Inpatient Sample. Pediatrics 120: e236-e243 [Abstract] [Full text]  
• Rundblad, G. (2007). Impersonal, General, and Social: The Use of Metonymy Versus Passive Voice in Medical Discourse. Written Communication 24: 250-277 [Abstract]  
• Grenier, D, Elliott, E J, Zurynski, Y, Rodrigues Pereira, R, Preece, M, Lynn, R, von Kries, R, Zimmermann, H, Dickson, N P, Virella, D (2007). Beyond counting cases: public health impacts of national Paediatric Surveillance Units. Arch. Dis. Child. 92: 527-533 [Abstract] [Full text]  
• Committee on Pediatric AIDS, Section on Internatio, (2007). Increasing Antiretroviral Drug Access for Children With HIV Infection. Pediatrics 119: 838-845 [Abstract] [Full text]  
• Cowburn, C, Hatherill, M, Eley, B, Nuttall, J, Hussey, G, Reynolds, L, Waggie, Z, Vivian, L, Argent, A (2007). Short-term mortality and implementation of antiretroviral treatment for critically ill HIV-infected children in a developing country. Arch. Dis. Child. 92: 234-241 [Abstract] [Full text]  
• Scherpbier, H. J., Bekker, V., Pajkrt, D., Jurriaans, S., Lange, J. M. A., Kuijpers, T. W. (2007). Once-Daily Highly Active Antiretroviral Therapy for HIV-Infected Children: Safety and Efficacy of an Efavirenz-Containing Regimen. Pediatrics 119: e705-e715 [Abstract] [Full text]  
• L'homme, R. F. A., Dijkema, T., Warris, A., van der Ven, A. J. A. M., Gibb, D. M., Burger, D. M. (2007). Pharmacokinetics of two generic fixed-dose combinations for HIV-infected children (Pedimune Baby & Pedimune Junior) are similar to the branded products in healthy adults. J Antimicrob Chemother 59: 92-96 [Abstract] [Full text]  
• Rosso, R., Di Biagio, A., Dentone, C., Gattinara, G. C., Martino, A. M., Vigano, A., Merlo, M., Giaquinto, C., Rampon, O., Bassetti, M., Gatti, G., Viscoli, C. (2006). Lopinavir/ritonavir exposure in treatment-naive HIV-infected children following twice or once daily administration. J Antimicrob Chemother 57: 1168-1171 [Abstract] [Full text]  
• Menson, E. N, Walker, A S., Sharland, M., Wells, C., Tudor-Williams, G., Riordan, F A. I, Lyall, E G H., Gibb, D. M, collaborative HIV paediatric study steering commit, (2006). Underdosing of antiretrovirals in UK and Irish children with HIV as an example of problems in prescribing medicines to children, 1997-2005: cohort study.. BMJ 332: 1183-1187 [Abstract] [Full text]  
• Scherpbier, H. J., Bekker, V., van Leth, F., Jurriaans, S., Lange, J. M.A., Kuijpers, T. W. (2006). Long-term Experience With Combination Antiretroviral Therapy That Contains Nelfinavir for up to 7 Years in a Pediatric Cohort. Pediatrics 117: e528-e536 [Abstract] [Full text]  
• Charakida, M., Donald, A. E., Green, H., Storry, C., Clapson, M., Caslake, M., Dunn, D. T., Halcox, J. P., Gibb, D. M., Klein, N. J., Deanfield, J. E. (2005). Early Structural and Functional Changes of the Vasculature in HIV-Infected Children: Impact of Disease and Antiretroviral Therapy. Circulation 112: 103-109 [Abstract] [Full text]  
• Prime, K P, Jungmann, E A, Edwards, S G (2004). Decline in mortality in children with HIV in the UK and Ireland: HIV positive adolescents urgently need dedicated services. BMJ 328: 524-524 [Full text]  
• Mhlongo, S W P, Maduna, P M H (2004). Decline in mortality in children with HIV in the UK and Ireland: Argument is flawed. BMJ 328: 523-523 [Full text]  

Rapid Responses:

Read all Rapid Responses

CASE FOR DECLINING MORTALITY AMONGST HIV-1 INFECTED CHILDREN IN THE UNITED KINGDOM AND IRELAND FLAWED!

Sam Wynstan MHLONGO, et al.
bmj.com, 18 Nov 2003 [Full text]

HIV positive adolescents-urgent need for dedicated services

Katarina P Prime, et al.
bmj.com, 21 Nov 2003 [Full text]