PEDIATRICS Vol. 99 No. 4 April 1997, p. e4
Copyright ©1997 by the American Academy of Pediatrics

ELECTRONIC ARTICLE:
A Descriptive Survey of Pediatric Human Immunodeficiency Virus-infected Long-term Survivors

Received Apr 24, 1996; accepted Jul 15, 1996.

Karin Nielsen^*, George McSherry, Ann Petru^**, Toni Frederick^§, Diane Wara, Yvonne Bryson^*, Natasha Martin, Cecelia Hutto^#, Arthur J. Ammann, Samuel Grubman^¶, James Oleske, and Gwendolyn B. Scott^#

From the ^* Department of Pediatrics, UCLA School of Medicine, Los Angeles, California;  Pediatric AIDS Foundation, Novato, California; ^§ Pediatric AIDS Surveillance Study, Los Angeles Pediatric AIDS Consortium, Los Angeles County Dept of Health Services, Los Angeles, California;  Department of Pediatrics, UMD-New Jersey Medical School and Children's Hospital of New Jersey, Newark, New Jersey; ^¶ Department of Pediatrics, Saint Vincents Hospital and Medical Center of New York, New York; ^# Department of Pediatrics, University of Miami School of Medicine, Miami, Florida; ^** Children's Hospital Oakland, Oakland, California; and  Department of Pediatrics, University of California, San Francisco School of Medicine, San Francisco, California.

Objective.  To identify the population of human immunodeficiency virus-infected pediatric long- term survivors (LTS) followed in major medical institutions in California, Florida and New Jersey.

Methods.  A cross-sectional survey was performed with data collection forms sent to all investigators. Demographic, clinical, and laboratory data were obtained on all living patients 8 years infected in the perinatal period with human immunodeficiency virus.

Results.  A total of 143 perinatally infected and 54 children infected by neonatal transfusion were identified. Fifty-four children (27%) had absolute CD4 counts 500 cells/mm (group 1: mean age 9.8 years), 54 children (27%) had CD4 counts between 200 and 500 cells/mm (group 2: mean age 10.1 years), and 89 children (45%) had CD4 counts <200 cells/mm (group 3: mean age 10.4 years). Ninety-five (48%) patients had developed AIDS defining conditions; 14 (26%) in group 1, 26 (48%) in group 2, and 55 (62%) in group 3. Ninety-two percent of patients had received antiretrovirals. Perinatally human immunodeficiency virus-infected children tended to be younger (mean age 9.8 years) than children infected via a blood transfusion (mean age 11 years). Generalized lymphadenopathy was the most prevalent clinical finding. Lymphoid interstitial pneumonia and recurrent bacterial infections were the most prevalent acquired immune deficiency syndrome-defining conditions. Twenty percent of LTS had CD4 counts 500 cells/mm and no immune deficiency syndrome-defining conditions.

Conclusions.  Pediatric LTS were in variable stages of disease progression. The proportion of children within each CD4 strata did not differ by mode of acquisition of infection. Increased CD4 counts were inversely proportional to age. Only 20% of pediatric LTS had minimal to no disease progression. HIV, pediatric long-term survivors, slow disease progression.

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