PEDIATRICS Vol. 106 No. 2 August 2000, p. e24
ELECTRONIC ARTICLE:
Predictors of Change in the Functional Status of Children With
Human Immunodeficiency Virus Infection
Received Dec 2, 1999; accepted Mar 8, 2000.
, §,
, ¶, #
From the Departments of * Epidemiology and Biostatistics,
Harvard School of Public Health, Boston, Massachusetts; § Department of
Family Medicine and Community Health, Tufts University School of
Medicine, Medford, Massachusetts; Division of Pediatric
Gastroenterology and Nutrition, Strong Children's Research Center,
University of Rochester School of Medicine, Rochester, New York;
¶ Combined Program in Pediatric Gastroenterology and Nutrition,
Children's Hospital, Boston, Massachusetts; and # Department of
Pediatrics, Harvard Medical School, Boston, Massachusetts.
Objective. The purpose of this study was to identify important clinical predictors of change in the functional status of children with perinatally acquired human immunodeficiency virus (HIV) infection.
Methods. Children who were perinatally exposed to HIV underwent evaluation of growth, nutritional, and functional status parameters as part of a prospective study of HIV and nutrition in children. The main outcome measures for HIV-infected children were change over time in: 1) Total Health, 2) General Health, and 3) Responsiveness as measured by the Functional Status II(R) (FSII[R]). Candidate predictors included anthropometric measurements, social factors, HIV disease stage, CD4 T lymphocyte count, medications, and other clinical markers of illness.
Results. The parents or legal guardians of 35 perinatally
HIV-infected children completed 2 FSII(R) surveys over a mean of 16 months. Functional Status scores were significantly correlated with
number of times and days hospitalized in the past 6 months and with
illness at the time of baseline evaluation. Functional status declined overtime on all 3 scales; however, only the change in Total Health score was statistically significant. Total, General Health, and Responsiveness scores declined by 
5 points in 20.0%, 17.1%, and 14.3% of children, respectively. Significant univariate predictors of
change in at least 1 component of the functional status survey included
race, guardianship, height z score, prescription of
antiviral medications other than antiretrovirals, and illness at time
of baseline evaluation. In multivariate models, adjusting for baseline score and biologic relationship of guardian completing survey, significant predictors of a decline in Total Health scores included non-white race and lower baseline height z
score. The General Health score declined with lower baseline absolute
CD4 count and lower baseline height z score. Finally,
Responsiveness scores declined in children whose guardian was their
biologic parent and in children with lower baseline height
z scores.
Conclusion. The FSII(R) questionnaire correlates with other markers of disease severity in children with HIV infection. Growth parameters, immune status, and social factors are important predictors of functional status in HIV-infected children. Key words: human immunodeficiency virus, children, functional status.
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