We describe our experience at Jackson Memorial Hospital in Miami, Florida, with 172 children who were given diagnoses of perinatally acquired infection with human immunodeficiency virus type 1 (HIV-1). The 146 mothers of the children acquired HIV-1 through heterosexual contact (69 percent), intravenous drug use (30 percent), or blood transfusion (1 percent). The children presented with symptomatic disease at a median age of eight months; only 21 percent presented after the age of two years. The most common first manifestations of disease were lymphoid interstitial pneumonia (in 17 percent), encephalopathy (in 12 percent), recurrent bacterial infections (in 10 percent), and candida esophagitis (in 8 percent), for which the median survival times from diagnosis were 72, 11, 50, and 12 months, respectively. Nine percent of the children had Pneumocystis carinii pneumonia at a median age of five months and had a median survival of only one month. The median survival for all 172 children was 38 months from the time of diagnosis. Mortality was highest in the first year of life (17 percent), and by proportional-hazard analysis the probability of long-term survival is low. In multivariate analyses, early age at diagnosis and the first identifiable pattern of clinical disease were found to be independently related to survival. We conclude that children with perinatally acquired HIV-1 infection have a very poor prognosis and that most become symptomatic before one year of age. Early diagnosis is important, since there is only a short interval in which to initiate prophylactic or antiviral treatment before progressive disease begins.
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Department of Pediatrics, University of Miami School of Medicine, Fla. 33101.
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Mueller, B. U.
(1998). Cancers in Human Immunodeficiency Virus-Infected Children. J Natl Cancer Inst Monogr
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[Abstract][Full Text]
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[Abstract][Full Text]
Mayaux, M.-J., Burgard, M., Teglas, J.-P., Cottalorda, J., Krivine, A., Simon, F., Puel, J., Tamalet, C., Dormont, D., Masquelier, B., Doussin, A., Rouzioux, C., Blanche, S., French Pediatric HIV Infection Study Group, , Pautard, B., Brault, D., Mamou, J., Broyart, A., Dandine, M., Hernandorena, X., Balde, P., Lachassine, E., Douard, D., Fleury, H., Masquelier, B., Gilles, I., Gantzer, A., Colin-Gorki, A-M., Brouard, J., Freymuth, F., Keros, L., Labrune, P., Vial, M., Mazy, F., Floch, C., Bourdon, P., Duval-Arnould, M., Huraux-Rendu, C., Lemerle, S., Boddaert, M., Denavit, M-F., Lahsinat, K., Pascal, C., Leblanc, A., May, A., Dallot, C., Dormont, D., Bader-Meunier, B., Dussaix, E., Tardieu, M., Seaume, H., Wipff, P., Deboisse, P., Michel, G., Tamalet, C., Vallee, D., Crumiere, C., Saillant, A., Lorier, B. L., Botto, C., Seguy, D., Talon, P., Huret, C., Nicolas, J., Lalande, J., Mechineau-Lacroix, F., Berterottiere, D., Cottalorda, J., Deville, A., Monpoux, F., de Crepy, A., Simon, F., Parat, S., Firtion, G., Ronzier, M., Brunner, C., Ciraru-Vigneron, N., Heller-Roussin, B., Blanche, S., Burgard, M., Girault, D., Rouzioux, C., Terris, J., Veber, F., Huraux, J-M., Noseda, G., Levine, M., Vilmer, E., Vallet, A., Marpeau, L., Mathieu, F. P., Aufrant, C., Francoual, C., Krivine, A., Herve, F., Courpotin, C., Dollfus, C., Moncomble, C. C., Rousset, M-C., Mouchnino, G., Brossard, V., Buffet-Janvresse, C., Robin, M., Labbe-Filou, F., Allemon, M. C., Retbi, J.-M., Narcy, P., Boulley, A.-M. R., Puel, J., Tricoire, J., Barin, F., Borderon, J.-C., Busuttil, R., Vinas, A., Guillot, F., Lacroix-Coutry., A.
(1996). Neonatal Characteristics in Rapidly Progressive Perinatally Acquired HIV-1 Disease. JAMA
275: 606-610
[Abstract]
Simonds, R.J., Lindegren, M. L., Thomas, P., Hanson, D., Caldwell, B., Scott, G., Rogers, M., The Pneumocystis carinii Pneumonia Prophylaxis Eva,
(1995). Prophylaxis against Pneumocystis carinii Pneumonia among Children with Perinatally Acquired Human Immunodeficiency Virus Infection in the United States. NEJM
332: 786-790
[Abstract][Full Text]
Bye, M. R., Cairns-Bazarian, A. M., Ewig, J. M.
(1994). Markedly Reduced Mortality Associated With Corticosteroid Therapy of Pneumocystis carinii Pneumonia in Children With Acquired Immunodeficiency Syndrome. Arch Pediatr Adolesc Med
148: 638-641
[Abstract]
Kotloff, K. L., Johnson, J. P., Nair, P., Hickman, D., Lippincott, P., Wilson, P. D., Clemens, J. D.
(1994). Diarrheal Morbidity During the First 2 Years of Life Among HIV-Infected Infants. JAMA
271: 448-452
[Abstract]
Blanche, S., Mayaux, M.-J., Rouzioux, C., Teglas, J.-P., Firtion, G., Monpoux, F., Cicaru-Vigneron, N., Meier, F., Tricoire, J., Courpotin, C., Vilmer, E., Griscelli, C., Delfraissy, J.-F., The French Pediatric HIV Infection Study Group,
(1994). Relation of the Course of HIV Infection in Children to the Severity of the Disease in Their Mothers at Delivery. NEJM
330: 308-312
[Abstract][Full Text]
Eppes, S. C., Turner, B. J., Markson, L. E.
(1994). Pneumocystis carinii Pneumonia in Children With Perinatally Acquired HIV Infection. JAMA
271: 102-102
[Abstract]
Fein, J. A., Friedland, L. R., Rutstein, R., Bell, L. M.
(1993). Children With Unrecognized Human Immunodeficiency Virus Infection: An Emergency Department Perspective. Arch Pediatr Adolesc Med
147: 1104-1108
[Abstract]
Simonds, R. J., Oxtoby, M. J., Caldwell, M. B., Gwinn, M. L., Rogers, M. F.
(1993). Pneumocystis carinii Pneumonia Among US Children With Perinatally Acquired HIV Infection. JAMA
270: 470-473
[Abstract]
Chamberlain, M. C.
(1993). Pediatric AIDS: A Longitudinal Comparative MRI and CT Brain Imaging Study. J Child Neurol
8: 175-181
[Abstract]
Armstrong, F. D., Seidel, J. F., Swales, T. P.
(1993). Pediatric HIV Infection: A Neuropsychological and Educational Challenge. J Learn Disabil
26: 92-103
[Abstract]
Katz, M. H., Mastrucci, M. T., Leggott, P. J., Westenhouse, J., Greenspan, J. S., Scott, G. B.
(1993). Prognostic Significance of Oral Lesions in Children With Perinatally Acquired Human Immunodeficiency Virus Infection. Arch Pediatr Adolesc Med
147: 45-48
[Abstract]
Abadco, D. L., Rao, M., Kravath, R. E., Steiner, P.
(1992). The Role of Assisted Ventilation in Survival After Respiratory Failure in Children With AIDS. Arch Pediatr Adolesc Med
146: 1052-1055
[Abstract]
Abadco, D. L., Amaro-Galvez, R., Rao, M., Steiner, P.
(1992). Experience With Flexible Fiberoptic Bronchoscopy With Bronchoalveolar Lavage as a Diagnostic Tool in Children With AIDS. Arch Pediatr Adolesc Med
146: 1056-1059
[Abstract]
Lepage, P., Van de Perre, P., Van Vliet, G., Nsengumuremyi, F., Van Goethem, C., Kestelyn, P., Msellati, P., Hitimana, D.-G.
(1991). Clinical and Endocrinologic Manifestations in Perinatally Human Immunodeficiency Virus Type 1--Infected Children Aged 5 Years or Older. Arch Pediatr Adolesc Med
145: 1248-1251
[Abstract]
Rutstein, R. M.
(1991). Predicting Risk of Pneumocystis carinii Pneumonia in Human Immunodeficiency Virus--Infected Children. Arch Pediatr Adolesc Med
145: 922-924
[Abstract]
(1991). Guidelines for Prophylaxis Against Pneumocystis carinii Pneumonia for Children Infected With Human Immunodeficiency Virus. JAMA
265: 1637-1644
Connor, E., Bagarazzi, M., McSherry, G., Holland, B., Boland, M., Denny, T., Oleske, J.
(1991). Clinical and Laboratory Correlates of Pneumocystis carinii Pneumonia in Children Infected With HIV. JAMA
265: 1693-1697
[Abstract]
Kovacs, A., Frederick, T., Church, J., Eller, A., Oxtoby, M., Mascola, L.
(1991). CD4 T-Lymphocyte Counts and Pneumocystis carinii Pneumonia in Pediatric HIV Infection. JAMA
265: 1698-1703
[Abstract]
Blanche, S., Tardieu, M., Duliege, A.-M., Rouzioux, C., Le Deist, F., Fukunaga, K., Caniglia, M., Jacomet, C., Messiah, A., Griscelli, C.
(1990). Longitudinal Study of 94 Symptomatic Infants With Perinatally Acquired Human Immunodeficiency Virus Infection: Evidence for a Bimodal Expression of Clinical and Biological Symptoms. Arch Pediatr Adolesc Med
144: 1210-1215
[Abstract]
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