Decline in mortality, AIDS, and hospital admissions in perinatally HIV-1 infected children in the United Kingdom and IrelandBMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7422.1019 (Published 30 October 2003) Cite this as: BMJ 2003;327:1019
- D M Gibb (), reader in epidemiology1,
- T Duong, statistician1,
- P A Tookey, senior lecturer in paediatric epidemiology2,
- M Sharland, consultant in paediatric infectious diseases3,
- G Tudor-Williams, senior lecturer4,
- V Novelli, consultant in paediatric infectious diseases5,
- K Butler, consultant in paediatric infectious diseases6,
- A Riordan, consultant in paediatric infectious diseases7,
- L Farrelly, clinical trials manager1,
- J Masters, research fellow2,
- C S Peckham, professor in epidemiology2,
- D T Dunn, senior statistician1 the National Study of HIV in Pregnancy and Childhood (NSHPC), the Collaborative HIV Paediatric Study (CHIPS)
- 1Medical Research Council Clinical Trials Unit, London NW1 2DA
- 2Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, London WC1N 1EH
- 3Paediatric Infectious Diseases Unit, St George's Hospital, London SW17 0QT
- 4Department of Paediatrics, St Mary's Hospital, London W2 1NY
- 5Great Ormond Street Hospital for Sick Children NHS Trust, London WC1N 3JH
- 6Our Lady's Hospital for Sick Children, Crumlin, Dublin 12, Republic of Ireland
- 7Birmingham Heartlands Hospital, Bordesley Green East, Birmingham B9 5SS
- Correspondence to: D M Gibb
- Accepted 18 August 2003
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.
Contributors The CHIPS steering committee are all authors on this paper. Additional contributors from the MRC Clinical trials Unit are A Babiker, D Johnson, V Leclezio, B Glickstein, G O'Connor, A S Walker, G Wait, and Y Sowunmi. DMG, DTD, TD and MS conceived the idea for this paper. DMG and MS developed the protocol for the CHIPS cohort and secured additional funding in collaboration with CSP and PAT. PAT is responsible for the NSHPC at the Institute of Child Health, and JM manages data collection and entry. At the MRC Clinical Trials Unit, LF and K Doerholt supervised data collection and data entry for CHIPS, assisted by S Masters, B Glickstein, G Wait, V Leclezio, G O'Connor. D Johnson and Y Sowunmi provided Oracle database support. TD conducted the statistical analyses under the supervision of DTD and input from A S Walker and A G Babiker. The paper was prepared by DMG and TD with PAT, CSP, A S Walker, and DTD. MS, GT-W, VN, KB, and AR ensured the quality of prospective data from their centres and commented on drafts of the paper. DMG is the guarantor for this study.
Funding NSHPC receives support from the Department of Health and the Medical Research Council. CHIPS has received additional support from Bristol-Myers Squibb, Boehringer Ingelheim, GlaxoSmithKline, Roche, Abbott, and Gilead.
Competing interests None declared.
Ethical approval The national study of HIV in pregnancy and childhood received renewed ethics approval, including follow up in the collaborative HIV paediatric study, in 2001 from Great Ormond Street Hospital for Children NHS Trust and the Institute of Child Health research ethics committee.