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To the Editor: Dr de Martino and colleagues¹ report a lower mortality rate among Italian children infected with HIV (human immunodeficiency virus) who were treated with multidrug regimens. However, we believe that these results may be biased. Because subjects entered the study only after they were diagnosed with HIV, only one third of the sample was followed up prospectively from birth. Asymptomatic children thus could be underrepresented, with a resulting overestimation of the mortality rate.

This issue is important in estimating the effect of multidrug regimens on mortality compared with the "natural history" of the disease in children before such regimens were available. Only prospective studies of mother-to-child HIV transmission allow a strictly prospective analysis of the disease because all the infected children are followed up from birth. For example, the mortality calculated from the French nationwide prospective study² is substantially lower than that reported for the study by de . . . [Full Text of this Article]

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