Published online November 30, 2007
PEDIATRICS Vol. 120 No. 6 December 2007, pp. e1476-e1480 (doi:10.1542/peds.2006-1503)
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ARTICLE

Influence of Institutionalization on Time to HIV Disease Progression in a Cohort of Romanian Children and Teens

Margaret Ferris, PhD, MPHa, Keith Burau, PhDb, Ana Maria Constantin, MAc, Stefania Mihale, MAc, Nancy Murray, DrPHb, Alina Preda, MAc, Michael Ross, MA, MS, PhD, MPHb and Mark W. Kline, MDa

a Department of Pediatrics, Baylor College of Medicine, Houston, Texas
b School of Public Health, University of Texas Health Sciences Center, Houston, Texas
c Romanian American Children's Center, Constanta, Romania

OBJECTIVES.The purpose of this work was to investigate the effect of institutionalization on death and CD4 decline in a cohort of 325 HIV-infected Romanian children.

METHODS. A retrospective database analysis was conducted. Data from a nearly 3-year period were examined with Kaplan-Meier survival analysis and Cox regression analysis models. Subjects all received primary and HIV specialty care and treatment at the Romanian American Children's Center in Constanta, Romania. Children in one group resided with their biological families and the other children resided in "family home"–style institutions.

RESULTS. There was no difference between groups for death during the follow-up period, although there was a trend for survival advantage for children in institutional care. There was no statistically significant difference between the study groups in terms of CD4 decline, although there was a trend toward greater decline among children who resided with their biological families. Children with their biological families were more likely to experience disease progression through either death or CD4 decline than were children in institutions.

CONCLUSIONS. The family home–style institution may prove to be a replicable model for the safe and appropriate care of HIV-infected orphaned and abandoned children and teens.

Key Words: HIV infection • Romania • institutionalization • child • disease progression

Abbreviations: RACC—Romanian American Children's Center • HAART—highly active antiretroviral therapy • CDC—Centers for Disease Control and Prevention

Accepted May 14, 2007.