Background: Combined antiretroviral therapy (cART) has been associated with a steep decrease in mortality and morbidity in HIV-1 infected children. New antiretroviral molecules and drug classes have been developed and the management of HIV-infected children has improved, but recent data on survival are limited. Methods: An observational retrospective study investigating changes in mortality and morbidity was conducted on 1,091 perinatally HIV-1 infected children enrolled in the Italian Register for HIV Infection in Children and followed-up from 2001 to 2018. Results: Three hundred and fifty-four (32%) AIDS events and 26 (2%) deaths occurred overtime. Mortality rates decreased from 0.4/100 person-years in 2001–2006 to 0.27/100 person-years in 2007–2012 and 0.07/100 person-years in 2013–2018. Notably, 92% of the dead children were born in Italy, but only 50% were followed-up since birth or within three months of age. Seventy three percent of children had started cART at age ≥6 months; 23% were treated for <30 days before death. B and C clinical events progressively decreased (P < 0.0001). Opportunistic infections significantly decreased over time, but still were the most common events in all the periods (6.76/100 person-years in 2013–2018). In the last period, severe bacterial infections were the most common ones. Cancer rates were 0.07/100; 0.17/100; 0.07/100 person-years in the three periods, respectively. Conclusions: Progressive reductions both in mortality and in rates of class B and C clinical events and OIs have been observed during the cART era. However, deaths were still registered; more than half of dead children were enrolled after birth and had belatedly started cART.
Real-World Analysis of Survival and Clinical Events in a Cohort of Italian Perinatally HIV-1 Infected Children From 2001 to 2018 / Chiappini, E.; Larotonda, F.; Lisi, C.; Giacomet, V.; Erba, P.; Bernardi, S.; Zangari, P.; Di Biagio, A.; Taramasso, L.; Giaquinto, C.; Rampon, O.; Gabiano, C.; Garazzino, S.; Tagliabue, C.; Esposito, S.; Bruzzese, E.; Badolato, R.; Zanaboni, D.; Cellini, M.; Dedoni, M.; Mazza, A.; Pession, A.; Giannini, A. M.; Salvini, F.; Dodi, I.; Carloni, I.; Cazzato, S.; Tovo, P. A.; de Martino, M.; Galli, L.. - In: FRONTIERS IN PEDIATRICS. - ISSN 2296-2360. - 9(2021). [10.3389/fped.2021.665764]
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