Trends in Mortality in the Pre- & Post-HAART Eras among HIV-Infected Children in the U.S. Perinatal AIDS Collaborative Transmission Study (PACTS) (1986-2004)

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Trends in Mortality in the Pre- & Post-HAART Eras among HIV-Infected Children in the U.S. Perinatal AIDS Collaborative Transmission Study (PACTS) ( ) B. Kapogiannis* 1, M. Soe 2, S. Nesheim 2, EJ. Abrams 3, J. Farley 4, P. Palumbo 5, LJ. Koenig 2, and M. Bulterys 2 National Institute of Child Health and Human Development (NICHD) / National Institutes of Health (NIH) 1, Bethesda, MD; Centers for Disease Control & Prevention (CDC) 2, Atlanta, GA; Harlem Hospital, Columbia University 3, NYC, NY; University of Maryland 4, Baltimore, MD and Dartmouth College 5, Hanover, NH. Background Background –HAART has improved AIDS-associated morbidity and mortality –Given the bimodal mortality distribution in HIV-infected children, it is important to evaluate temporal effects of HAART among a pure birth cohort with long-term, prospective follow-up. Methods Methods –CDC-sponsored multi-center, prospective birth cohort study of HIV-exposed infants enrolled to monitor MTCT and pediatric HIV progression. –HIV-infected children followed through 4/04 –Average annual mortality calculated for no/mono-therapy (≤12/31/90), mono/dual-therapy (1/1/91-12/31/96) and HAART eras (≥1/1/97) –Mortality trends evaluated using survival analysis and Poisson regression –Extended Cox proportional-hazards regression models (Cox PH) estimated the effect of HAART on mortality

Results Results –Among 364 children, 98 died  61 were < 2 y/o; 18 more were between 2 – 3 y/o. –Ten-year survival of those who ever received HAART and of non-HAART recipients was 94% and 45% (P<0.05) Survival probability among HAART recipients (defined by age of initiation of HAART) vs. non-recipients Trends in Mortality in the Pre- & Post-HAART Eras among HIV-Infected Children in the U.S. Perinatal AIDS Collaborative Transmission Study (PACTS) ( ) B. Kapogiannis* 1, M. Soe 2, S. Nesheim 2, EJ. Abrams 3, J. Farley 4, P. Palumbo 5, LJ. Koenig 2, and M. Bulterys 2 National Institute of Child Health and Human Development (NICHD) / National Institutes of Health (NIH) 1, Bethesda, MD; Centers for Disease Control & Prevention (CDC) 2, Atlanta, GA; Harlem Hospital, Columbia University 3, NYC, NY; University of Maryland 4, Baltimore, MD and Dartmouth College 5, Hanover, NH.

Results (cont’d) Results (cont’d) –HAART-associated declines in mortality remained significant after controlling for birth year, CD4%, anthropometrics (HAZ & WAZ) and maternal CDC classification (Cox PH model, HR=0.25: 95%CI ) Conclusions Conclusions –A significant decrease in annual mortality and a prolongation in survival were seen among HAART recipients in this U.S. perinatal cohort of HIV-infected children –Advances in antiretroviral therapy led to commensurate improvements in crude annual mortality rates (Log-Rank test P<0.05) –Using Poisson regression to adjust for gender, race, prematurity, era- entry age, AZT prophylaxis, maternal AIDS class and IVDU hx, the mortality rate ratios in the no/mono- and mono/dual- therapy eras were ~30-fold (P<0.01) and ~9-fold (P<0.01) higher, respectively, than in the HAART era Trends in Mortality in the Pre- & Post-HAART Eras among HIV-Infected Children in the U.S. Perinatal AIDS Collaborative Transmission Study (PACTS) ( ) B. Kapogiannis* 1, M. Soe 2, S. Nesheim 2, EJ. Abrams 3, J. Farley 4, P. Palumbo 5, LJ. Koenig 2, and M. Bulterys 2 National Institute of Child Health and Human Development (NICHD) / National Institutes of Health (NIH) 1, Bethesda, MD; Centers for Disease Control & Prevention (CDC) 2, Atlanta, GA; Harlem Hospital, Columbia University 3, NYC, NY; University of Maryland 4, Baltimore, MD and Dartmouth College 5, Hanover, NH.