AEGiS-15IAC: The pediatric AIDS severity score (PASS): A multidimensional AIDS severity adjustment for pediatric HIV infection.

15th International AIDS Conference

Bangkok, Thailand - July 11-16, 2004

The pediatric AIDS severity score (PASS): A multidimensional AIDS severity adjustment for pediatric HIV infection.

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. TuOrB1190)

McIntosh K, Seage GR, Buchacz K, Weinberg GA, Dankner WM
Harvard School of Public Health, Boston, MA, United States

BACKGROUND: A staging system predictive of severity for perinatally HIV-infected children is needed for clinical and research purposes, particularly in resource-poor settings.

METHODS: A Pediatric AIDS Severity Score (PASS) was developed using baseline sociodemographic, clinical, immunologic, and functional measures obtained from 1178 perinatally HIV-infected children enrolled into a prospective cohort study, (PACTG 219). PASS was then validated among 952 perinatally HIV-infected children enrolled in other PACTG research studies at the same sites. Survival estimates and Hazard Ratios (HR) were obtained using the Kaplan Meier method and proportional hazards models, respectively. The most predictive models were determined using Harrell's "C" statistic.

RESULTS: Overall survival was 95% and 90% at one and two years of follow-up, respectively. The most comprehensive model for predicting mortality, termed the "Full" Pediatric AIDS Severity Score (FULL PASS), included CD4% less than 15 (HR=4.9), CDC category C (HR=2.8), a low (<70) or invalid neuropsychological score (HR=2.4), a general health rating of less then 5 (HR=2.6) and an elevated symptoms score (HR=3.3). These determinants were highly predictive of mortality (C statistic = 0.850). For resource limited settings, a Simple PASS model was developed using the same cohort, which included CD4% less than 15 (HR=5.5), CDC category C (HR=3.2) and weight less then the 10th percentile (HR=1.7). These determinants were also highly predictive of mortality (C statistic = 0.831) using a separate validation data set.

CONCLUSIONS: PASS will be helpful in assessing the effectiveness of ART among children with HIV infection, particularly when randomized clinical trials are not possible due to ethical concerns. [The authors thank the PACTG 219 Study Team for their collaboration.]

Keywords: AEGIS, Acquired Immunodeficiency Syndrome, HIV Infections, Centers for Disease Control and Prevention (U.S.), HIV Seropositivity, Cohort Studies, Prospective Studies, Child

040711
TuOrB1190