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Pediatric Infectious Disease Journal:
doi: 10.1097/INF.0b013e318211399f
Original Studies

Causes of Death in Pediatric Patients Vertically Infected by the Human Immunodeficiency Virus Type 1 in Madrid, Spain, From 1982 to Mid-2009

Palladino, Claudia PhD*; Climent, Francisco J. MD†; José, Ma Isabel De MD‡; Jimenez De Ory, Santiago BSc*; Bellón, Jose María MSc§; Guillén, Sara MD¶; Gurbindo, Ma Dolores MD∥**; González-Tomé, Isabel MD†; Mellado, Ma José MD‡‡; Martínez Pérez, Jorge MD§§; Calvo, Cristina MD¶¶; Ramos, José Tomás MD¶; Muñoz-Fernández, Ma Ángeles PhD, MD***

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Abstract

Background: Effective therapies have increased life expectancy of human immunodeficiency virus (HIV)-infected pediatric patients. We investigated the underlying causes of death, mortality, and acquired immune deficiency syndrome (AIDS) rates in HIV-infected pediatric patients in Madrid, Spain.

Methods: We studied a multicenter cohort of 478 HIV-infected pediatric patients in Madrid. Mortality and AIDS incidence rates, causes of death, CD4+ T-cell, and HIV RNA were analyzed during calendar periods (CPs): pre-HAART (highly active antiretroviral therapy) (CP1: 1982–1996) and post-HAART era (CP2: 1997–2009).

Results: During 5690 person-years of follow-up 157 (32.8%) deaths occurred. Median age at death increased (CP1: 3.2 years [1.0–6.3] vs. CP2: 7.7 years [3.1–11.4]; P < 0.01). Mortality and AIDS rates decreased 10.6-fold (95% confidence intervals [CI]: 6.9–16.7) and 6.9-fold (95% CI: 5.0–9.6), respectively, between CPs. Nevertheless, mortality was 10.4-fold (95% CI: 5.8–18.8; P < 0.001) higher than in age-similar general population in late-CP2. In all, 169 causes of death were reported. Multiple causes were reported in 16 of 151 (10.6%) patients. In 81.1% (137/169), the causes were AIDS-defining, 11.8% (20/169) HIV-related, and 7.1% (12/169) non-HIV-related. Infections were the leading causes (60.8%, 101/166); from 1999 to 2007 the risk of death from infections was 115.9 times (95% CI: 42.0–265.8; P < 0.001) higher than in the age-similar general population. Comorbidity was reported in 66.9% (101/151) of patients. Median HIV-1 RNA at death decreased (CP1: 5.9 [5.0–6.3]; CP2: 5.3 [4.2–5.8]; P < 0.01).

Conclusions: Despite decline in mortality and AIDS rates, it is important to monitor all causes of death as prolonged survival might allow underlying comorbidity to become more clinically relevant.

© 2011 Lippincott Williams & Wilkins, Inc.

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