Sir.—We read with interest the article by Blanche et al1 on infants with perinatally acquired human immunodeficiency virus (HIV) infection. We too have noted a bimodal pattern of HIV-related disease in our pediatric patients with acquired immunodeficiency syndrome (AIDS).2 In the last few years we have become aware of a third pattern of HIV infection in children, namely, severe manifestations of disease early in life that lessen over the next 5 to 10 years without antiretroviral therapy. This pattern is illustrated in the following patient reports of three HIV-infected children born to drug-abusing mothers.
Patient Reports.—PATIENT 1.—A 10-year-old black twin boy was born be tween 34 and 36 weeks' gestation. He weighed 1520 g at birth. His Apgar scores were 8/9 at 1 and 5 minutes. The boy had an uncomplicated neonatal course and was discharged after 2 weeks weighing 1950 g. Within his first 10