• 1 From the The Kirby Institute, UNSW, Sydney, Australia
  • 2 Pediatric Institute, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
  • 3 Department of Pediatrics, Faculty of Medicine, and Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
  • 4 Cipto Mangunkusumo - Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
  • 5 Penang Hospital, Penang, Malaysia
  • 6 Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand
  • 7 National Centre for HIV/AIDS, Dermatology and STDs, Phnom Penh, Cambodia
  • 8 Children's Hospital 1, Ho Chi Minh City, Vietnam
  • 9 Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
  • 10 Department of Pediatrics, Faculty of Medicine and Research Unit in Pediatric and Infectious Diseases, Chulalongkorn University
  • 11 Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
  • 12 National Hospital of Pediatrics, Hanoi, Vietnam
  • 13 Children's Hospital 2, Ho Chi Minh City, Vietnam
  • 14 YRGCARE Medical Centre, CART CRS, Chennai, India
  • 15 Hospital Raja Perempuan Zainab II, Kelantan, Malaysia
  • 16 Hospital Likas, Kota Kinabalu, Malaysia
  • 17 Sanglah Hospital, Udayana University, Bali, Indonesia
  • 18 TREAT Asia/amfAR - The Foundation for AIDS Research, Bangkok, Thailand
Pediatr Infect Dis J, 2019 03;38(3):287-292.
PMID: 30281549 DOI: 10.1097/INF.0000000000002208


BACKGROUND: Perinatally HIV-infected adolescents (PHIVA) are exposed to a chronic systemic infection and long-term antiretroviral therapy (ART), leaving them susceptible to morbidities associated with inflammation, immunodeficiency and drug toxicity.

METHODS: Data collected 2001 to 2016 from PHIVA 10-19 years of age within a regional Asian cohort were analyzed using competing risk time-to-event and Poisson regression analyses to describe the nature and incidence of morbidity events and hospitalizations and identify factors associated with disease-related, treatment-related and overall morbidity. Morbidity was defined according to World Health Organization clinical staging criteria and U.S. National Institutes of Health Division of AIDS criteria.

RESULTS: A total 3,448 PHIVA contributed 17,778 person-years. Median age at HIV diagnosis was 5.5 years, and ART initiation was 6.9 years. There were 2,562 morbidity events and 307 hospitalizations. Cumulative incidence for any morbidity was 51.7%, and hospitalization was 10.0%. Early adolescence was dominated by disease-related infectious morbidity, with a trend toward noninfectious and treatment-related morbidity in later adolescence. Higher overall morbidity rates were associated with a CD4 count <350 cells/µL, HIV viral load ≥10,000 copies/mL and experiencing prior morbidity at age <10 years. Lower overall morbidity rates were found for those 15-19 years of age compared with 10-14 years and those who initiated ART at age 5-9 years compared with <5 or ≥10 years.

CONCLUSIONS: Half of our PHIVA cohort experienced a morbidity event, with a trend from disease-related infectious events to treatment-related and noninfectious events as PHIVA age. ART initiation to prevent immune system damage, optimize virologic control and minimize childhood morbidity are key to limiting adolescent morbidity.

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