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PEDIATRICS Vol. 113 No. 6 June 2004, pp. e544-e551

ELECTRONIC ARTICLE

Psychiatric Hospitalizations Among Children and Youths With Human Immunodeficiency Virus Infection

Denise M. Gaughan, MPH*,{ddagger}, Michael D. Hughes, PhD{ddagger}, James M. Oleske, MD, MPH§, Kathleen Malee, PhD||, Carol A. Gore, Sharon Nachman, MD# for the Pediatric AIDS Clinical Trials Group 219C Team

* National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia
{ddagger} Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts
§ Department of Pediatrics, University of Medicine and Dentistry of New Jersey, Newark, New Jersey
|| Departments of Infectious Diseases and Child and Adolescent Psychiatry, Children's Memorial Hospital, Chicago, Illinois
Community Constituency Group, Conroe, Texas
# Department of Pediatric Infectious Disease, State University of New York, Health Science Center, Stony Brook, New York

Objective. Psychiatric manifestations of pediatric human immunodeficiency virus (HIV) infection have been described. However, data on severe sequelae requiring hospitalization among this population have not been reported.

Methods. The Pediatric Acquired Immunodeficiency Syndrome (AIDS) Clinical Trials Group (PACTG) 219C is a prospective cohort study designed to examine long-term outcomes among HIV-infected children and HIV-uninfected infants born to HIV-infected women. Children with HIV infection who have enrolled in PACTG 219C are examined quarterly, with collection of clinical and laboratory data. Hospitalizations and diagnoses for all participants between September 2000 (when enrollment into PACTG 219C was started) and December 2002 were reviewed.

Results. Among 1808 HIV-infected participants who were <15 years of age at the last visit date, 25 children had been hospitalized for psychiatric manifestations, 8 before enrollment into PACTG 219C. Seventeen children were hospitalized during 2757 person-years of follow-up monitoring after entry into PACTG 219C, which represents an incidence of 6.17 cases per 1000 person-years (95% confidence interval: 3.59–9.87 cases per 1000 person-years). This was significantly higher than the incidence of 1.70 cases per 1000 person-years (95% confidence interval: 1.67–1.72 cases per 1000 person-years) in the general pediatric population <15 years of age, as reported in the 2000 National Hospital Discharge Survey, yielding a relative rate of 3.62 (95% confidence interval: 2.11–5.80). A total of 32 HIV-infected children, regardless of age, were hospitalized because of psychiatric illnesses. The majority of patients were admitted because of depression (n = 16) or behavioral disorders (n = 8). Fifteen (47%) underwent multiple psychiatric hospitalizations. The median age at the first psychiatric hospitalization was 11 years (range: 4–17 years); all patients had been perinatally infected. Knowledge of HIV seropositivity status and having experienced a significant life event were both significantly associated with an increased risk of psychiatric hospitalization (hazard ratios of 6.13 and 3.04, respectively). No psychiatric hospitalizations were observed among the 1021 HIV-uninfected members of the cohort.

Conclusions. Children with HIV/AIDS are at increased risk for psychiatric hospitalizations during childhood and early adolescence, compared with the general pediatric population. Knowledge of HIV seropositivity status and recent significant life events were significantly associated with increased risks of admission in this population.

Key Words: HIV/AIDS • pediatrics • psychiatric hospitalization • psychologic distress • disclosure • proportional hazards regression

Abbreviations: HIV, human immunodeficiency virus • AIDS, acquired immunodeficiency syndrome • PACTG, Pediatric AIDS Clinical Trials Group • NHDS, National Hospital Discharge Survey • WITS, Women and Infants Transmission Study

Received for publication Oct 3, 2003; Accepted Jan 8, 2004.


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