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HIV-infected children with CD4 cell counts less than 100/cu mm-survival analysis and clinical course.
Henderson SL; Nesheim SR; Clark WS; Sawyer M; Nahmias AJ; Emory
January 30, 1997
Int Conf AIDS. 1996 Jul 7-12;11(2):116 (abstract no. We.B.3338). Unique

Objective: To evaluate the clinical progression and survival of HIV-infected children with very low CD4 cell counts as a potential focus population for antiviral and immune therapy modalities. Methods: A retrospective chart review was performed of children followed from 1987 to 1995. Survival times [from time CD4 counts fell below 100/cu mm to outcomes (i.e. death)] were estimated with Kaplan-Meier methods. Results: For 42 perinatally-infected children, CD4 counts fell less than 100 at a median age of 2.2 years (range=3 weeks-7.4 years), with a median survival time after CD4 less than 100 of 1.3 years. There was a relatively larger proportion of encephalopathy and opportunistic infections in children with CD4 less than 100 below age 3 years than above. Survival analysis showed a trend toward longer survival for children with CD4 less than 100 after age 3 (median survival=2.3 years). The median survival was 1.2 years for CD4 less than 100 before age 3 years (p= 0.04, Log-Rank; p= 0.14, Wilcoxon)]. Survival was significantly shorter for infants with CD4 less than 100 before 1 year of age (median survival = 0.96 years), compared to ages 1-2 years and above 2 years (p=0.016). table: see text) Conclusion: There are differences in survival and clinical progression of children with very low CD4 counts relative to the age at which they drop, most notably in children within the first year of life. These findings correlate with the immune pattern of thymic deficiency that we have recently demonstrated in infants less than 1 year of age.