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Sharon A. Nachman, MD; Miriam Chernoff, MD; Philimon Gona, MD; Russell B. Van Dyke, MD; Wayne M. Dankner, MD; George R. Seage III, ScD, MPH; James Oleske, MD, MPH; Paige L. Williams, PhD; for the PACTG 219C Team

Arch Pediatr Adolesc Med. 2009;163(2):164-171.

Objective  To estimate highly active antiretroviral therapy (HAART)–era incident rates for the first episode of noninfectious conditions in human immunodeficiency virus (HIV)–infected youth in order to identify HAART-era changes in the natural history of perinatal HIV infection.

Design  Multicenter prospective cohort study.

Setting  More than 80 sites in the United States including Puerto Rico.

Patients  Perinatally HIV-infected youth.

Main Outcome Measures  Incidence rates (IRs) per 100 person-years were calculated for targeted noninfectious conditions occurring in perinatally HIV-infected children. A ² test for linear trend was used to evaluate changes in the rates from 2001 to 2006.

Results  Two thousand five hundred seventy-five perinatally HIV-infected children (51%, female; 59%, black, non-Hispanic) were enrolled in Pediatric AIDS Clinical Trials Group (PACTG) 219C between 2000 and 2006 and were followed up for a median of 59 months. The 10 most common noninfectious conditions were pregnancy conditions (IR = 6.16; 95% confidence interval (CI), 3.9-9.3), birth defects (IR = 0.19; 95% CI, 0.1-0.3), gynecological dysplasias (IR = 5.92; 95% CI, 3.9-8.6), condyloma (IR = 0.15; 95% CI, 0.1-0.2), encephalopathy (IR = 0.38; 95% CI, 0.3-0.5), pancreatitis (IR = 0.30; 95% CI, 0.2-0.4), cardiac disorders (IR = 0.28; 95% CI, 0.2-0.4), renal disorders (IR = 0.26; 95% CI, 0.2-0.4), peripheral neuropathy (IR = 0.23; 95% CI, 0.2-0.4), and idiopathic thrombocytic purpura (IR = 0.15; 95% CI, 0.1-0.3). Among these conditions, 5 showed significant trends, with IRs increasing over time in pregnancy-related conditions (P < .001) and gynecological dysplasias (P = .02) while IRs decreased over time for encephalopathy (P < .001), pancreatitis (P = .002), and cardiac disorders (P = .007).

Conclusions  Between 2001 and 2006, the incidence for 3 conditions decreased and increased for 2 others, demonstrating the change in medical issues and conditions in perinatally infected youth. Continued surveillance with appropriate tools will be needed to assess the long-term effects of HAART and HIV as well as development of new noninfectious conditions of HIV.

Author Affiliations: State University of New York at Stony Brook (Dr Nachman); Statistical and Data Analysis Center, Harvard School of Public Health (Drs Chernoff, Seage, and Williams), and Department of Mathematics and Statistics, Boston University (Dr Gona), Boston, Massachusetts; Tulane University, New Orleans, Louisiana (Dr Van Dyke); Duke University, Durham, North Carolina (Dr Dankner); and University of Medicine and Dentistry of New Jersey, Newark (Dr Oleske).

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