Decline in mortality in children with HIV in the UK and Ireland: Authors' reply

doi:10.1136/bmj.328.7438.524-a

BMJ 2004;328:524 (28 February), doi:10.1136/bmj.328.7438.524-a

Letter

Decline in mortality in children with HIV in the UK and Ireland

Authors' reply

The first 150 words of the full text of this article appear below.

EDITOR—Mhlongo and Maduna and Prime et al challenge theresults of our study and think that we overlooked alternativereasons for the rapid fivefold decline in mortality, progressionto AIDS, and hospital admission rates we reported in the CHIPScohort of vertically HIV infected children in the United Kingdomand Ireland. We cannot agree that they provide viable alternativeexplanations for the dramatic reduction.

Firstly, we did not include details of management of opportunisticinfections, and we agree that there is indirect evidence thatcotrimoxazole prophylaxis reduces the frequency of these (particularlyPneumocystis carinii pneumonia in infancy, as previously reportedin the United Kingdom¹). This does not explain the magnitudeor the timing of the effect we observed; cotrimoxazole prophylaxishas been widely used in HIV infected children in the UnitedKingdom and Ireland since the early 1990s, as evidenced by itsinclusion in guidelines in 1994, . . . [Full text of this article]

D M Gibb, reader in epidemiology

mbh@ctu.mrc.ac.uk, Medical Research Council Clinical Trials Unit, London NW1 2DA

T Duong, statistician

Medical Research Council Clinical Trials Unit, London NW1 2DA

P A Tookey, senior lecturer in paediatric epidemiology

Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, London WC1N 1EH

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