Hospitalization Trends Among Children and Youths With Perinatal Human Immunodeficiency Virus Infection, 1990–2002

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Background:Major improvements in disease progression among HIV-infected children have followed the adoption of combination antiretroviral therapy.Methods:We examined trends in hospitalization rates between 1990–2002 among 3927 children/youths with perinatal HIV infection, ranging in age from newborn to 21 years. We used Poisson regression to test for trends in hospitalization rates by age and year; binomial regression to test for trends in intensive care unit (ICU) admissions and hospitalization at least once and more than once, by age and year; and multivariate logistic regression to examine factors associated with hospitalization, ICU admission, and hospitalization longer than 10 days.Results:Statistically significant downward trends in hospitalization rates and multiple hospitalizations were observed in all age groups from 1990–2002. The proportion of HIV-infected children/youths who were hospitalized at least once declined from 30.4% in 1990 to 12.9% in 2002, with a steady decline occurring after 1996, when the U.S. Public Health Service issued guidelines recommending triple-drug antiretroviral therapy (triple therapy) for HIV-infected children. ICU admissions declined significantly in all age groups except among children younger than 2 years. Logistic regression results indicated that black and Hispanic children/youths were significantly more likely to be hospitalized than white children/youths and that children/youths receiving triple therapy were significantly more likely to be hospitalized than therapy-naive children; the latter association was not observed among children monitored from 1997–2002.Conclusions:Substantial reductions in rates of hospitalization, multiple hospitalizations, and ICU admission have occurred among HIV-infected children/youths from 1990–2002, particularly after 1996, with increased use of triple therapy.

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