Hospitalisation Rates Down for Young Kids With HIV

NEW YORK - The introduction and widespread use of highly active antiretroviral therapy (HAART) in the United States has led to "dramatic decreases" in hospitalizations among HIV-infected infants and children younger than 5 years old, new evidence suggests.

However, the decrease in hospital use has been less noteworthy among HIV-infected adolescent.

Dr. Athena P. Kourtis from the Centers for Disease Control and Prevention, Atlanta and colleagues used the National Inpatient Sample database to analyze trends in hospital use by HIV-infected children and adolescents in the 10 years between 1994 (before HAART) and 2003 (after widespread HAART use).

According to the team's report in the journal Pediatrics, there were an estimated 3,420 hospitalizations of HIV-infected children aged 18 or younger in 2003 compared with 11,785 in 1994 -- a decrease of 71 percent.

As mentioned, this decrease was more marked among infants and pre-school children (94 percent for boys and 92 percent for girls) than among adolescents (decrease of 47 percent for boys and increase of 23 percent among girls between 15 and18 years of age).

The inpatient fatality rates for HIV-infected children also fell from 5.0 percent in 1994 to 1.8 percent in 2003.

The data show that hospitalizations for several HIV-related conditions are much less common in the HAART era compared with the pre-HAART era. These include bacterial pneumonia caused by Pneumocystis jiroveci; general bacterial infections; sepsis, serious systemic infections; fungal infections; brain infections (encephalitis); and failure to thrive.

No significant changes were observed in the number of hospitalizations for two other common opportunistic infections -- Pneumococcus or cytomegalovirus infections.

Kourtis and colleagues hope these data can be used to "examine our progress;" assess the health care needs of specific HIV-infected groups, such as adolescents, and for specific HIV-related conditions, such as pneumococcus and CMV; and "define future policies in an era of competing health care priorities."

SOURCE: Pediatrics, August 2007.