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  • Title: Estimating the incubation period of paediatric AIDS in Rwanda.
    Author: Commenges D, Alioum A, Lepage P, Van de Perre P, Msellati P, Dabis F.
    Journal: AIDS; 1992 Dec; 6(12):1515-20. PubMed ID: 1492934.
    Abstract:
    OBJECTIVE: To estimate the distribution of the incubation period of paediatric AIDS in Rwanda. DESIGN: Data were collected between February 1984 and December 1990 at the Centre Hospitalier de Kigali (CHK), the capital city of Rwanda, Central Africa. PATIENTS: We used a sample of 685 AIDS cases registered consecutively in the Department of Paediatrics of the CHK, in which the proportion of perinatally acquired HIV-1 infection was estimated to be 98.6%. METHODS: We performed both non-parametric and parametric analyses. The methods of estimation were adapted to truncated data, using essentially the same methods as Auger et al. in their analysis of data from the New York City and the New York State AIDS case registries in 1988. RESULTS: We found that a double Weibull model fitted the data very well and that the risk of developing AIDS was high for subjects under 18 months of age, but lower for older subjects. CONCLUSIONS: Our results were qualitatively similar to those of Auger et al.. There were quantitative differences between the two studies, but it was not possible to compare median survival periods. Parameters such as median or mean survival times cannot be validly estimated using only data from registers because these data exclude infected subjects who have not yet developed AIDS. The authors used nonparametric and parametric methods and data on 685 AIDS cases at the Centre Hospitalier de Kigali, collected between February 1984 and December 1990, to estimate the distribution of pediatric AIDS in Kigali, Rwanda. 98.6% of the cases probably acquired AIDS via vertical transmission. A combination of the 2 Weibul distributions (parametric method) resulted in a good fit, suggesting that the sample population consisted of a subpopulation with a short incubation period and an other with a longer incubation period. The researchers could not deduce proof of heterogeneity from the shape of the distribution, however. The probability of developing AIDS during the first year of life was 0.29, which corresponded with that of the European Collaborative Study (0.26). The risk of developing pediatric AIDS increased considerably for children less than 18 months old but fell and became constant for older children. The qualitative findings matched those of a study in New York City. Even though quantitative differences between this study and the other study existed, the researchers could not compare median survival times. Since data from registers did not include HIV-infected children who had not yet developed AIDS, the researchers were not able to estimate median and mean survival periods. A possible source of bias was that the data were from a surveillance system based on cases at just 1 hospital, which probably did not see all pediatric AIDS cases. In conclusion, truncated data determined rather well the distribution of incubation periods, but could not provide much information about the scale parameters of the model.
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