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Trends in Antiretroviral Therapy Use and Survival Rates for a Large Cohort of HIV-Infected Children and Adolescents in the United States, 1989-2001

McConnell, Michelle S MD*††; Byers, Robert H PhD; Frederick, Toni PhD; Peters, Vicki B MD§; Dominguez, Kenneth L MD, MPH; Sukalac, Thom; Greenberg, Alan E MD, MPH; Hsu, Ho-Wen MD; Rakusan, Tamara A MD¶‡‡; Ortiz, Idith R MD, MPH#; Melville, Sharon K MD**; Fowler, Mary Glenn MD, MPHfor the Pediatric Spectrum of HIV Disease Consortium

JAIDS Journal of Acquired Immune Deficiency Syndromes: April 1st, 2005 - Volume 38 - Issue 4 - p 488-494
doi: 10.1097/
Epidemiology and Social Science

Background: In the United States, HIV-infected children and adolescents are aging and using antiretroviral (ARV) therapy for extended periods of time.

Objective: To assess trends in ARV use and long-term survival in an observational cohort of HIV-infected children and adolescents in the United States.

Methods: The Pediatric Spectrum of HIV Disease Study (PSD) is a prospective chart review of more than 2000 HIV-infected children and adolescents. Patients were included in the analysis from enrollment until last follow-up.

Results: Triple-ARV therapy use (for 6 months or more) increased from 27% to 66% during 1997 to 2001 (P < 0.0001, χ2 for trend). The proportion of patients receiving 3 or more sequential triple-therapy regimens also increased from 4% to 17% during 1997 to 2001 (P < 0.0001, χ2 for trend), however, and the durability of triple-therapy regimens decreased from 13 to 7 months from the first to third regimen. Survival rates for the 1997 to 2001 birth cohorts were significantly better than for the 1989 to 1993 and 1994 to 1996 cohorts (P < 0.0001).

Conclusions: Survival rates in the PSD cohort have increased in association with triple-ARV therapy use. With continued changes in ARV regimens, effective modifications in ARV therapy and the sustainability of gains in survival need to be determined.

From the *Division of Applied Public Health Training, Centers for Disease Control and Prevention, Atlanta, GA; †Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA; ‡Los Angeles County Department of Health, Los Angeles, CA; §New York City Department of Health and Mental Hygiene, New York, NY; ∥State Laboratories Institute, Jamaica Plain, MA; ¶Children's National Medical Center, Washington, DC; #Puerto Rico Department of Health, San Juan, PR; **Texas Department of Health, Austin, TX; ††Global AIDS Program, Centers for Disease Control and Prevention, Atlanta, GA; and ‡‡George Washington University School of Medicine, Washington, DC.

Received for publication February 3, 2004; accepted May 24, 2004.

Supported by the Division of HIV/AIDS, Centers for Disease Control and Prevention, under cooperative agreements U64/CCU303310, U64/CCU206818, U64/CCU114918, U64/CCU603300, U64/CCU903273, and U64/CCU202212.

A previous preliminary report of this study was made at the XIV International AIDS Conference, Barcelona, July 7-12, 2002.

Reprints: Michelle S. McConnell, Global AIDS Program, CDC 1600 Clifton Road, MS-E04, Atlanta, GA 30333 (e-mail:

© 2005 Lippincott Williams & Wilkins, Inc.