Distribution of the latency period for perinatally acquired AIDS

In the United States, over 86 per cent of paediatric cases of acquired immunodeficiency syndrome (AIDS) were infected through maternal or perinatal transmission and current estimates suggest that approximately 6000 children are born to infected women each year. In industrialized countries, less than 25 per cent of infants maternally exposed to the human immunodeficiency virus (HIV) are infected. The exact time of infection is unknown. However an endpoint, birth, exists from which the latency period or the time to diagnosis with clinical AIDS can be measured. In New York City, 7 years of reliable surveillance data were available for children with perinatally acquired AIDS. Using these data, the only estimable aspect of the latency is a conditional distribution, which conditions on diagnosis occurring before age 7. Because newborns carry maternal antibodies, a positive antibody test at birth is only an indication of maternal infection. Screening all newborns for HIV antibodies, while maintaining the anonymity of the mother and child, provides data on the number of children maternally exposed. The above conditioning can be removed by combining the surveillance and newborn screening data to obtain the unconditional latency distribution. We estimate a median diagnosis age of 4.1 years, somewhat longer than previously believed.