RESUMO
OBJECTIVES: To evaluate clinical conditions associated with mortality in HIV-infected children with CD4+ counts <100 cells/microl. METHODS: The Pediatric Spectrum of HIV Disease Project is a longitudinal medical record review study with eight study sites in the United States, which have been enrolling children since 1989. Survival time from baseline very low CD4 count (<100 cells/microl) to death was estimated using the Kaplan-Meier method. Cox proportional hazards models were used to evaluate the effect of clinical variables on mortality. RESULTS: Of 522 children (>/=1 year of age) with serial CD4+ T-lymphocyte measurements, the median age at the first very low CD4 count was 4.8 years. The estimated median survival following the first very low CD4 count was 36 months. The following factors present at the first very low CD4 count were independently associated with a higher risk of death: younger age, weight-for-age >2 standard deviations below the mean, and previously diagnosed AIDS. The subsequent development of cytomegalovirus (CMV)-associated disease, Mycobacterium avium intracellulare (MAI) infection, wasting syndrome, or esophageal candidiasis was also independently associated with a higher risk of death. CONCLUSION: Survival in HIV-infected children with very low CD4 counts before introduction of highly active antiretroviral therapy was highly variable. Poor nutritional status and the development of CMV disease or MAI infection were associated with the shortest survival times.
Assuntos
Linfócitos T CD4-Positivos/citologia , Infecções por HIV/mortalidade , Fatores Etários , Peso Corporal , Contagem de Linfócito CD4 , Infecções por Citomegalovirus , Feminino , Previsões , Infecções por HIV/imunologia , Infecções por HIV/transmissão , Síndrome de Emaciação por Infecção pelo HIV/imunologia , Síndrome de Emaciação por Infecção pelo HIV/mortalidade , Humanos , Lactente , Recém-Nascido , Transmissão Vertical de Doenças Infecciosas , Estudos Longitudinais , Masculino , Infecção por Mycobacterium avium-intracellulare , Modelos de Riscos Proporcionais , Porto Rico , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , Estados UnidosRESUMO
OBJECTIVE: To compare mortality of wasting syndrome (WS) versus Pneumocystis carinii pneumonia (PCP) in AIDS patients reported in Puerto Rico after controlling for gender, age, and CD4 levels. METHODS: AIDS patients for which a diagnosis of WS (n = 1,180) or PCP (n = 765), who were reported to the AIDS Surveillance System of Puerto Rico between 1989 and 1992, were used to analyze the mortality risk among these diagnoses using a Cox's proportional hazard regression model. RESULTS: Cox model showed that WS patients had a 14% to 33% reduction in mortality risk compared with PCP patients after adjusting for gender and age (95% confidence level). Mortality risks for males were 18% (95% CI: 1%, 39%) higher than females risk after adjusting for AIDS defining condition and age. It was shown that a decrease in 100 CD4 cells increased the mortality by 37% (95% CI: 16%, 62%) after adjusting for AIDS defining conditions, gender, and age.
Assuntos
Síndrome da Imunodeficiência Adquirida/mortalidade , Síndrome de Emaciação por Infecção pelo HIV/mortalidade , Pneumonia por Pneumocystis/mortalidade , Síndrome da Imunodeficiência Adquirida/imunologia , Adulto , Fatores Etários , Idoso , Contagem de Linfócito CD4 , Intervalos de Confiança , Feminino , Síndrome de Emaciação por Infecção pelo HIV/imunologia , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia por Pneumocystis/imunologia , Modelos de Riscos Proporcionais , Porto Rico/epidemiologia , Fatores SexuaisRESUMO
OBJECTIVE: To compare mortality of wasting syndrome (WS) versus Pneumocystis carinii pneumonia (PCP) in AIDS patients reported in Puerto Rico after controlling for gender, age, and CD4 levels. METHODS: AIDS patients for which a diagnosis of WS (n = 1,180) or PCP (n = 765), who were reported to the AIDS Surveillance System of Puerto Rico between 1989 and 1992, were used to analyze the mortality risk among these diagnoses using a Cox's proportional hazard regression model. RESULTS: Cox model showed that WS patients had a 14 per cent to 33 per cent reduction in mortality risk compared with PCP patients after adjusting for gender and age (95 per cent confidence level). Mortality risks for males were 18 per cent (95 per cent CI: 1 per cent, 39 per cent) higher than females risk after adjusting for AIDS defining condition and age. It was shown that a decrease in 100 CD4 cells increased the mortality by 37 per cent (95 per cent CI: 16 per cent, 62 per cent) after adjusting for AIDS defining conditions, gender, and age.