Purpose: To determine the impact on quality-adjusted life-years (QALYs) associated with perinatal HIV infection when the child's infection is classified annually using the traditional approach, i.e., worst lifetime clinical classification, compared with the child's worst clinical classification during the current calendar year. The newer approach allows for clinical improvements over time due to better treatment.

Methods: Using data from the Pediatric Spectrum of Disease for 1,900 perinatally HIV-infected children who were participating in the study in 2001, we stratified participants into 5 age groups: 0 years, 1-4 year, 5-9 years, 10-14 years and 15 years and greater. Within each age group, we assessed the proportion of children with an HIV clinical classification of N (no symptoms), A or B (symptomatic) and C (severe symptoms) using two approaches – worst-ever lifetime clinical classification and the worst clinical classification during the previous 12 months. We assigned a utility weight to each clinical classification from the published literature and computed an overall utility weight for each age. Using a discount rate of 3% and an assumed life expectancy of 15 years, we determined expected quality-adjusted life-years under both approaches.

Results: Under the traditional approach, the utility-adjusted weight was 88.25 for the first year of life, compared with 88.50 under the new approach; it was 82.70 and 89.25 for years 1 through 4 under the old and new approaches, respectively; 79.96 and 89.78 ,for years 5-9; 79.83 and 89.32, for years 10-15; and 78.57 and 88.36 for years 15 and older, under the old and new approaches, respectively. Lifetime quality-adjusted years under the old approach were 9.93, 10% lower than the 10.98 years generated by the new approach.

Conclusions: Assessing utility in perinatally HIV-infected individuals associated with their most recent disease clinical classification increases their expected lifetime quality-adjusted life years, holding years of survival constant. The new approach may provide a more realistic estimate against which to assess the costs and benefits of perinatal HIV prevention and treatment; it reflects advances in treatment efficacy and the improved clinical status of those infected.