Kids more likely to be treated for AIDS

American children with HIV are more likely to use health care services than infected adults according to a study performed by the Johns Hopkins University School of Medicine.

"Because infants and toddlers are more likely to visit their pediatrician on a regular basis, and because physicians believe that administering highly active antiretroviral therapy (HAART) to babies and infants early on helps establish and maintain levels of viral suppression, we weren't really surprised by these results," explained a press release issued by Dr. George Sibbery, a pediatrician at the Children's Center and the study's lead author.

"However, our study is believed to be one of the first to examine health care utilization patterns of HIV-infected children since the widespread use of HAART -- also suggests that the demand for care for HIV-positive children means we need to look carefully at how we are delivering it and what more we can do to improve access and services," he added. The published report is scheduled for presentation Nov. 3 at the American Academy of Pediatrics 2003 National Conference and Exhibition in New Orleans, La.

According to scientists at Johns Hopkins and the HIV Research Network, HIV-positive infants up to the age of two make frequent outpatient visits and are often hospitalized. Furthermore, 90 percent of all HIV-infected children receive antiretroviral (ART) medications.

According to the U.S. Department of Health and Human Services, by the year 2001 there were more than 170,000 adults and adolescents and approximately 4,000 children in the United States infected with the HIV virus.

"An understanding of how real HIV patients access the health care system, and what services they do or do not utilize, provides policymakers, medical providers and HIV program managers with the knowledge to make important decisions on HIV care that reflects what is really happening out there in the HIV community," said Siberry, in a recently issued press release.

Currently examined in the study is the examination of the clinical records of 364 HIV-infected children seen in 2000 at five pediatric sites of the HIV Research Network. The children, mostly female and African-American, were all infected by transmission of the virus from their infected mother during pregnancy or delivery.

Researchers mainly focused on the number of inpatient and outpatient visits, in addition to how many children were given the appropriate treatment. They discovered that HIV-infected children had an average of eight yearly outpatient visits and a one-in-three possibility of needing inpatient admission in the year 2000. HIV-infected infants, and children two and under, had more than nine outpatient visits per year and a two-in-three possibility of being admitted during that year.

When analyzing statistics of healthy children in the United States to HIV-infected children, the HIV infected children are hospitalized 10 times more often and have three times as many yearly outpatient visits. Although hospitalization rates for children with HIV were somewhat lower than the rates of HIV-infected adults, they the children had 30 percent more outpatient visits.

Children with more advanced HIV infection, high viral loads, AIDS, or those of non-Caucasian ethnicity, in addition to HIV-infected infants under the age of two, had significantly more outpatient visits and hospitalizations in 2000.

"The good news from these findings is that hospitalization rates and outpatient visits for HIV-infected children appear to be three to four times lower than they were for HIV-infected children in the early 1990s when HAART therapy was not available," said Siberry, in a recent press release.

The HIV Research Network (HIVRN) comprises 18 medical institutions located across the nation that treat more than 16,000 patients with HIV disease.

Assembling data on the clinical and demographic characteristics of its HIV-infected patients, each of these institutions state the frequency of each patient's outpatient clinic visits and the number of inpatient admissions.

Affiliate institutions then send the information to the data coordinating center located at JHMI, where the received information is placed in several complex databases. From JHMI, scientists can access the information and examine general social trends.

Co-authors of this study include Kelly Gebo of the Johns Hopkins University School of Medicine; Richard Rutstein of Children's Hospital of Philadelphia; Patricia Flynn of St. Jude's Children's Hospital; and Stephen Spector of the University of California-San Diego.

This study should indicate the importance of making health services more accessible to the public.