The Pediatric AIDS Severity Score (PASS): A Multidimensional AIDS-Severity Adjustment for Pediatric HIV Infection

BACKGROUND:A severity staging system predictive of mortality for perinatally HIV-infected children is needed for clinical and research purposes. METHODS:A pediatric AIDS severity score (PASS) was developed using baseline sociodemographic, clinical, immunologic, and functional measures obtained from 786 perinatally HIV-infected children enrolled into a prospective cohort study (PACTG 219) in the pre-highly active antiretroviral therapy (HAART) era (pre-1996). PASS was then validated among 392 perinatally HIV-infected children randomly sampled from the original source population (n = 1178). Survival estimates and hazard ratios (HRs) were obtained using the Kaplan-Meier method and proportional hazards models, respectively. The most predictive models were determined using Harrellʼs “C” statistic. RESULTS:Overall survival was 95% and 90% at 1 and 2 years of follow-up, respectively. The most comprehensive model for predicting mortality, termed the “Full” PASS, included CD4%