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The use of highly active antiretroviral therapy (HAART) for human immunodeficiency virus (HIV)-infected patients has reduced the number of acquired immune deficiency syndrome-related deaths worldwide. This study assessed the impact of HAART on the survival and death rates of vertically HIV-infected children and adolescents in Belo Horizonte, Brazil. Data were obtained from a historic cohort of vertically HIV-infected children and adolescents aged zero-19 years old who were admitted from March 1989-December 2004 and were followed until June 2006. Patients who used HAART were included if they were treated for at least 12 weeks. Of 359 patients, 320 patients met the inclusion criteria. The overall mortality rate was 9.7% [31/320; 95% confidence interval (CI): 6.0-13%]. The median survival for the non-HAART and HAART groups was 31.5 and 55.9 months, respectively (log rank = 22.11, p < 0.0001). In the multivariate analysis, the statistically significant variables were HAART and the weight-for-age Z score < -2, with HAART constituting a protective factor [relative risk (RR): 0.13; CI 95%: 0.05-0.33] and malnutrition constituting a risk factor (RR: 3.44; CI 95%: 1.60-7.40) for death. The incidence of death was 5.1/100 person-years in the non-HAART group and 0.8/100 person-years in the HAART group (p < 0.0001).

OBJETIVO: Analisar a utilidade da contagem total de linfócitos, contagem global de leucócitos, hemoglobina, estado nutricional, contagem de linfócitos T CD4+ e carga viral como marcadores de progressão da doença e/ou óbito em crianças infectadas pelo HIV. MÉTODOS: Estudo de coorte retrospectiva em população de crianças infectadas pelo HIV, assintomáticas ou com sintomas leves e/ou moderados e virgens de tratamento antirretroviral. Os eventos de interesse foram: progressão para categoria clínica C (de acordo com a classificação dos Centers for Disease Control and Prevention - CDC, de 1994) ou óbito. Valores da contagem global de leucócitos, contagem total de linfócitos, hemoglobina, escore z peso/idade, contagem de linfócitos T CD4+ e carga viral plasmática obtidos à admissão foram considerados na análise do risco de ocorrência dos eventos de interesse. A população foi estratificada em faixas etárias: 12 e < 36, > 36 e < 60 meses. RESULTADOS: Cento e vinte pacientes, admitidos entre 1997 e 2003, preencheram os critérios para inclusão deste estudo. A mediana global do tempo de acompanhamento foi de 7,4 meses (intervalo interquartil 25-75% = 3,8-21,1). Em análise multivariada, apenas a contagem de linfócitos T CD4+, segundo as categorias da Organização Mundial da Saúde, e o escore z peso/idade ≤ -2 foram preditores do risco de progressão da doença em crianças maiores de 12 meses de idade. Em menores de 12 meses, nenhuma das variáveis analisadas esteve associada ao risco de progressão. CONCLUSÃO: Evidencia-se a importância do estado nutricional na avaliação do risco de progressão da doença em crianças maiores de 12 meses de idade infectadas pelo HIV. OBJECTIVE: To analyze total lymphocyte count, total leukocyte count, hemoglobin levels, nutritional status, CD4+ T-lymphocyte count and viral load as markers of disease progression and/or death in HIV-infected children. METHODS: This retrospective cohort study assessed antiretroviral naïve HIV-infected children who were asymptomatic or had mild and/or moderate symptoms. The events of interest were: progression to clinical category C (according to the classification of the Centers for Disease Control and Prevention - CDC, 1994) or death. Values of total leukocyte count, total lymphocyte count, hemoglobin, weight-for-age z score, CD4+ T-lymphocyte count and plasma viral load obtained at admission were considered in the risk analysis of events of interest. The population was stratified into age groups: < 12, > 12 to < 36, > 36 to < 60 months. RESULTS: One hundred and twenty patients, admitted between 1997 and 2003, met the inclusion criteria for the present study. The total median of follow-up duration was 7.4 months (25-75% interquartile range = 3.8-21.1). In the multivariate analysis, only CD4+ T-lymphocytes count, according to the categories of the World Health Organization, and weight-for-age z score ≤ -2 were predictors of risk for disease progression in children older than 12 months. In children younger than 12 months, none of the variables was associated with risk of progression. CONCLUSION: Nutritional status is an important aspect in the assessment of risk of disease progression in HIV-infected children older than 12 months.

This study aimed to evaluate the prognostic value of WHO clinical staging system in HIV-infected children and adolescents in Belo Horizonte, Brazil. WHO clinical stages were evaluated for risk of disease progression in 335 patients admitted from 1989 to 2003. In Kaplan-Meier analysis, age, clinical stage, CD4%15% and viral load5 log(10) were statistically significant. In Cox proportional hazards model, the relative risk of disease progression for Stage 4 at admission and in the worst moment were 3.47 [confidence interval (CI) 95% CI = 1.92-6.26] and 2.89 (95% CI = 1.44-5.79). Stages 2 and 3 were neutral as predictors of risk either of disease progression. CD4%15% and viral load5 log(10) remained statistically significant in multivariate analysis. WHO clinical Stage 4 was a good predictor of risk of progression in this cohort. The findings support WHO proposition to start antiretroviral treatment for patients at a more advanced clinical stage.

To analyze total lymphocyte count, total leukocyte count, hemoglobin levels, nutritional status, CD4+ T-lymphocyte count and viral load as markers of disease progression and/or death in HIV-infected children.This retrospective cohort study assessed antiretroviral naïve HIV-infected children who were asymptomatic or had mild and/or moderate symptoms. The events of interest were: progression to clinical category C (according to the classification of the Centers for Disease Control and Prevention - CDC, 1994) or death. Values of total leukocyte count, total lymphocyte count, hemoglobin, weight-for-age z score, CD4+ T-lymphocyte count and plasma viral load obtained at admission were considered in the risk analysis of events of interest. The population was stratified into age groups:12,or= 12 to36,or= 36 to60 months.One hundred and twenty patients, admitted between 1997 and 2003, met the inclusion criteria for the present study. The total median of follow-up duration was 7.4 months (25-75% interquartile range = 3.8-21.1). In the multivariate analysis, only CD4+ T-lymphocytes count, according to the categories of the World Health Organization, and weight-for-age z scoreor= -2 were predictors of risk for disease progression in children older than 12 months. In children younger than 12 months, none of the variables was associated with risk of progression.Nutritional status is an important aspect in the assessment of risk of disease progression in HIV-infected children older than 12 months.

The impact of highly active antiretroviral therapy (HAART) can be evaluated using indicators, such as rates of opportunistic infections, hospitalizations by cause of infection, and associated death. This study aimed to estimate the impact of HAART on the incidence of these indicators, in children and adolescents with HIV/AIDS. It was a hybrid cohort study; 371 patients were followed from 1989 to 2003. In December 2003, 76% of the patients were still being followed, while 12.1% had died, 9.5% had dropped out, and 2.4% had been transferred. The overall rate of opportunistic infections was 18.32 infections/100 persons-year and 2.63 in the pre- and post-HAART periods, respectively. In the multivariate analysis, the risk of developing an opportunistic infection was 5.4 times greater and 3.3 times greater for hospitalization risk before HAART. Respiratory causes represented 65% of the hospitalizations and they were reduced by 44.6% with therapeutic intervention. The average hospital stay of 15 days was reduced to 9.There was a post-HAART decline in deaths of 38%. This study demonstrates the effectiveness of HAART in significantly reducing opportunistic infections, hospitalizations, and deaths in this Brazilian cohort.O impacto da terapia anti-retroviral de alta potência ativa (HAART) pode ser avaliado utilizando-se indicadores, como taxas de incidências de infecções oportunistas, hospitalizações por causas infecciosas e mortalidade associada. O objetivo deste trabalho foi estimar o impacto da HAART na incidência desses indicadores em crianças e adolescentes com HIV/AIDS. Trata-se de uma coorte híbrida, na qual foram acompanhados 371 pacientes no período de 1989-2003. Em dezembro de 2003, 76% dos pacientes permaneciam em acompanhamento, 12,1% faleceram, 9,5% foram perda de seguimento e 2,4% transferidos. A taxa de incidência global de infecções oportunistas foi de 18,32 infecções/100 pessoas-ano e 2,63 nos períodos pré e pós-HAART, respectivamente. Na análise multivariada, risco relativo de desenvolvimento de infecção oportunista foi 5,4 vezes maior e 3,3 vezes maior para hospitalizações, antes da HAART. Causas respiratórias representaram 65% das hospitalizações, sendo reduzidas em 44,6% com a intervenção terapêutica. A mediana de duração das hospitalizações apresentou queda: 15 para 9 dias. Houve 38% de declínio nos óbitos pós-HAART. Este estudo demonstrou a efetividade da HAART, associando-a com significativa redução na incidência das infecções oportunistas, hospitalizações e mortalidade nesta coorte brasileira.