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Context: The effect of early antiretroviral therapy (ART) on the early progres sion of perinatal human immunodefi-ciency virus (HIV) infection is not well def ined. Objective: To examine early disease progression and survival in a populati on-based cohort with perinatal HIV infection in relation to year of birth and u se of ART. Design, Setting, and Patients: Retrospective study of temporal trends in early progression of perinatal HIV infection among 205 HIV-infected childre n in Northern California born between January 1, 1988, and December 31, 2001, an d followed up through age 3 years. Main Outcome Measures: Prevalence of and age at progression to a first US Centers for Disease Control and Prevention category C diagnosis relative to year of birth, type of ART, and age at initiation of th erapy. Results: Of 205 children, 134 (65%) received ART and/or Pneumocystis jir oveci pneumonia prophylaxis. By age 3 years, 81 (40%) progressed to a category C diagnosis, 41 (51%) of whom died. Untreated children were significantly more likely to progress to a category C diagnosis (62%[44/71] untreated vs 28%[37/1 34] treated children, P<.001); none of 23 infants who received triple ART progre ssed to category C. However, even without triple ART, very early mono/dual ART ( by age 2 months vs 3-4 months) was associated with delayed and decreased progression to categ ory C (P=.02). Of 33 children born between January 1, 1996, and December 31, 200 1, only 7 (21%) progressed to category C (P=.02 compared with 1988-1995), 6 of 7 of whom received no therapy. More recent year of birth and more advanced ther apy were associated with improved survival. Conclusions: This population-based cohort demonstrated decreased early HIV progression and improved survival at age 3 years, associated with more advanced therapy. Although limited by small sampl e size, the findings suggest that very early treatment, even without triple ART, was associated with improved outcome.
Context: The effect of early antiretroviral therapy (ART) on the early progres sion of perinatal human immunodefi-ciency virus (HIV) infection is not well defined. Objective: To examine early disease progression and survival in a populati on-based cohort with perinatal HIV infection in relation to year of birth and u se of ART. Design, Setting, and Patients: Retrospective study of temporal trends in early progression of perinatal HIV infection among 205 HIV-infected childre n in Northern California born between January 1, 1988 , and December 31, 2001, an d followed up through age 3 years. Main Outcome Measures: Prevalence of and age at progression to a first US Centers for Disease Control and Prevention category C diagnosis relative to year of birth, type of ART, and age at initiation of th erapy. Results: Of 205 children, 134 (65%) received ART and / or Pneumocystis jir oveci pneumonia prophylaxis. By age 3 years, 81 (40%) progressed to a category C diagnosis, 41 ) of of died. Unt reated children were significantly more likely to progress to a category C diagnosis (62% [44/71] untreated vs 28% [37/1 34] treated children, P <.001); none of 23 infants who received triple ART progre ssed Of category with either or without triple ART, very early mono / dual ART (by age 2 months vs 3-4 months) was associated with delayed and decreased progression to categyx C (P = .02). Of 33 children born Between January 1, 1996, and December 31, 200 1, only 7 (21%) progressed to category C (P = .02 compared with 1988-1995), 6 of 7 of whom received no therapy. More recent year of birth and more advanced ther apy were associated with improved survival. Conclusions: This population-based cohort demonstrated decreased partially HIV progression and improved survival at age 3 years, associated with more advanced therapy. Although limited by small sampl e size, the findings suggest that very early treatment, even without triple ART, was associated with improved outcome.