Affiliations 

  • 1 The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia
  • 2 Children's Hospital 1, Ho Chi Minh City, Vietnam
  • 3 Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn University
  • 4 Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok
  • 5 Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand
  • 6 National Centre for HIV/AIDS, Dermatology and STDs, Phnom Penh, Cambodia
  • 7 Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen
  • 8 Department of Pediatrics, Faculty of Medicine, and Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
  • 9 National Hospital of Pediatrics, Hanoi
  • 10 Children's Hospital 2, Ho Chi Minh City, Vietnam
  • 11 YRGCARE Medical Centre, CART CRS, Chennai, Tamil Nadu, India
  • 12 Hospital Raja Perempuan Zainab II, Kelantan, Malaysia
  • 13 Cipto Mangunkusumo - Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
  • 14 Hospital Likas, Kota Kinabalu, Malaysia
  • 15 Sanglah Hospital, Udayana University, Bali, Indonesia
  • 16 Penang Hospital, Penang, Malaysia
  • 17 TREAT Asia/amfAR - The Foundation for AIDS Research, Bangkok, Thailand
  • 18 Pediatric Institute, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
AIDS, 2018 Jul 31;32(12):1689-1697.
PMID: 29794827 DOI: 10.1097/QAD.0000000000001883

Abstract

OBJECTIVES: The aim of this study was to describe characteristics of perinatally HIV-infected adolescents (PHIVAs), factors associated with mortality, and outcomes at transition.

DESIGN: Ongoing observational database collating clinical data on HIV-infected children and adolescents in Asia.

METHODS: Data from 2001 to 2016 relating to adolescents (10-19 years) with perinatal HIV infection were analysed to describe characteristics at adolescent entry and transition and combination antiretroviral therapy (cART) regimens across adolescence. A competing risk regression analysis was used to determine characteristics at adolescent entry associated with mortality. Outcomes at transition were compared on the basis of age at cART initiation.

RESULTS: Of 3448 PHIVA, 644 had reached transition. Median age at HIV diagnosis was 5.5 years, cART initiation 7.2 years and transition 17.9 years. At adolescent entry, 35.0% had CD4 cell count less than 500 cells/μl and 51.1% had experienced a WHO stage III/IV clinical event. At transition, 38.9% had CD4 cell count less than 500 copies/ml, and 53.4% had experienced a WHO stage III/IV clinical event. Mortality rate was 0.71 per 100 person-years, with HIV RNA ≥1000 copies/ml, CD4 cell count less than 500 cells/μl, height-for-age or weight-for-age z-score less than -2, history of a WHO stage III/IV clinical event or hospitalization and at least second cART associated with mortality. For transitioning PHIVA, those who commenced cART age less than 5 years had better virologic and immunologic outcomes, though were more likely to be on at least second cART.

CONCLUSION: Delayed HIV diagnosis and cART initiation resulted in considerable morbidity and poor immune status by adolescent entry. Durable first-line cART regimens to optimize disease control are key to minimizing mortality. Early cART initiation provides the best virologic and immunologic outcomes at transition.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.