Clinical outcomes improve with highly active antiretroviral therapy in vertically HIV type-1-infected children

Background. Use of antiretroviral therapy has resulted in a decrease in morbidity and mortality rates in human immunodeficiency virus type 1 ( HIV-1) -infected children. Methods. We performed a retrospective study involving 427 children to determine the effectiveness of different antiretroviral therapy protocols on clinical outcome. The follow-up period was divided into 5 calendar periods ( CPs): CP1 ( 1980 - 1989), before antiretroviral therapy was administered; CP2 ( 1990 - 1993), when monotherapy was administered; CP3 ( 1994 - 1996), when combined therapy was administered; CP4 ( 1997 - 1998), when <= 50% of children were receiving highly active antiretroviral therapy ( HAART); and CP5 ( 1999 - 2003), when >= 60% of children were receiving HAART. Results. Children experienced a progressive increase in the CD4(+) cell count and decrease in the viral load from 1997 onwards. A lower number of AIDS cases and deaths occurred during CP5 than during the other CPs (), with a relative risk of an absence of AIDS of 120 and a relative risk of survival of > 30. The AIDS rate P < .01 was > 50% in CP1; we observed a very strong decrease to 14% in CP2, to 16% in CP3, to 7% in CP4, and to 2% in CP5. The mortality rates in CP2 and CP3 were 16% and thereafter decreased to 0.5% in CP5. The relative risks for no hospital admission in CP4 and CP5 were > 3.5. The total rates of hospital admission in CP1, CP2, and CP3 were > 30%; we observed a decrease in CP4 and CP5. The duration of hospitalization decreased during the follow-up period, and it was higher in CP1 (similar to 30 days) than in the other periods. Conclusions. We observed that HAART produces a decrease in adverse clinical outcomes ( i.e., hospital admission, AIDS, and death) in children with vertical HIV-1 infection in Madrid, Spain.