Children infected with HIV do not necessarily develop AIDS to a set pattern but can be divided into long-term and short-term survivors. We examined long-term survival in children perinatally infected with HIV-1. Out of a total of 624, we studied 182 children who survived longer than 5 years (long-term survivors (LTS)) and 120 children who died of HIV-1-related disease before 5 years (defined as short-term survivors (STS)). 28 (15%) LTS were symptomless (Centers for Disease Control (CDC) P-1 children). 154 (85%) had symptoms (CDC P-2). The proportion of LTS with less than 0.2 x 109/CD4 cells per L was 24/116 (21%) at 61-72 months, rising to 11/26 (41%) at more than 96 months.
On at least one occasion, p24 antigenaemia was observed in 112 (62%) LTS.Annual rate of CD4 cell loss was lower in LTS (25% (95% CI: 21-29)) than in STS (53% (45-60)) and in LTS symptomless or with solitary P-2A signs (17%; (13-21)) than in LTS with severe manifestations (30% (25-35)).
A new outlook emerges.A substantial number of children do survive after early childhood; severe diseases, low CD4 cell numbers, and p24 antigenaemia do not necessarily preclude long-term survival. The study shows that a CD4 cell decrease early in life can be predictive of outcome.