Changes in deaths reported with human immunodeficiency virus infection among United States children less than thirteen years old, 1987 through 1999.

Background: With implementation of highly active antiretroviral therapy during 1995 through 1999, deaths reported in adults with HIV infection decreased 67%, and the proportions of those accompanied by various opportunistic infections decreased, whereas their proportions with possibly unrelated conditions (e.g. diseases of liver, kidneys and heart) increased.

Objective: To examine changes among deaths of children with HIV infection.

Methods: We analyzed multiple-cause death certificate data with any mention of HIV infection for all US deaths at ages <13 years from 1987 through 1999. We examined changes in the numbers and rates of deaths and the proportions reported with various diseases.

Results: The annual number of children who died with HIV infection increased from 274 in 1987 to 511 in 1994 and then decreased by 81% to 97 in 1999. The median age at death increased from 1 year in 1987 to 5 years in 1999. During the periods 1987 through 1991 (1652 deaths), 1992 through 1995 (1906 deaths) and 1996 through 1999 (762 deaths), the proportion of deaths with pneumocystosis decreased from 19.0% to 9.9% and 7.5%, respectively. In a comparison of 1992 through 1995 with 1996 through 1999, no significant change occurred in the proportions of deaths with nontuberculous mycobacteriosis (5.6% to 6.0%), cytomegalovirus disease (3.2% to 4.4%), heart disease (10.8% to 11.7%), kidney disease (5.0%), liver disease (3.9% to 4.1%) or wasting/cachexia (4.0% to 5.0%).

Conclusions: Deaths with HIV infection among children have decreased substantially, probably because of both highly active antiretroviral therapy and prevention of perinatal HIV transmission. The decrease after 1995 was greater proportionally among children than among adults, but fewer changes in disease proportions occurred among children.