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Background: The population of perinatally HIV-infected adolescents (PHA) continues to expand globally. This study aims to describe the geographic and temporal characteristics and outcomes of PHA.
Methods: Through the Collaborative Initiative for Paediatric HIV Education and Research (CIPHER), individual retrospective data from 12 cohort networks were pooled. Included PHA entered care before age 10 years with no known non-vertical route of HIV infection, and were followed beyond age 10 years. This initial analysis describes characteristics at first visit, start of antiretroviral therapy (ART), start of adolescence (age 10 years) and surviving patients at last follow-up.
Results: Of 37,614 PHA included, 49.4% (18,591) were male and 79% were from sub-Saharan Africa (Table 1). Median (interquartile range [IQR]) follow-up during adolescence was 2.36 (1.00-4.35) years, ranging from 2.04 (0.87-3.77, sub-Saharan Africa) to 6.38 (3.51-8.01, Europe & Central Asia) years.

RegionCountries includedN (%)Observation periodDuration of follow-up during adolescence - median (IQR) yearsCumulative Mortality % (95% CI)
South & Southeast AsiaCambodia, India, Indonesia, Malaysia, Myanmar, Thailand, Vietnam2,902 (7.7)1994-20142.53 (1.17; 4.37)2.98 (2.08; 4.25)
Europe & Central AsiaBelgium, France, Ireland, Italy, Netherlands, Poland, Portugal, Romania, Russian Federation, Spain, Sweden, Switzerland, Ukraine, United Kingdom3,058 (8.1)1982-20156.36 (3.51; 8.01)0.78 (0.50; 1.21)
South America & CaribbeanArgentina, Brazil, Haiti, Honduras903 (2.4)1990-20154.92 (2.68; 7.37)4.72 (3.33; 6.65)
North AmericaUnited States of America1,048 (2.8)1991-20143.73 (2.01; 5.43)1.09 (0.52; 2,24)
Sub-Saharan AfricaBenin, Botswana, Burkina Faso, Burundi, Cameroon, Central African Republic, Democratic Republic of Congo, Côte d''Ivoire, Ethiopia, Ghana, Guinea, Kenya, Lesotho, Malawi, Mozambique, Rwanda, Senegal, South Africa, Swaziland, Tanzania, Togo, Uganda, Zambia, Zimbabwe29,703 (79.0)1996-20152.04 (0.87; 3.77)3.59 (3.26; 3.96)
[Table 1: Countries, periods of observation, duration of follow-up and cumulative mortality between 10 and 15 years of age by region]

90.7% (34,132) of PHA received ART; 9.9% (3,385) started after age 10 years. Age, CD4 count, CD4 percent and HIV viral load at first visit and ART start varied markedly across regions (Table 2). Although laboratory markers improved by age 10 years, median weight-for-age (WAZ), height-for-age (HAZ) and body mass index-for-age (BMIZ) WHO Z-scores changed little. Median HAZ at age 10 years and last visit remained well below zero in all regions, although BMIZ was less impaired.

 First visitART startAge 10 years (+/- 6 months)Last visit
 Total Median (IQR)Min & max region mediansTotal Median (IQR)Min & max region mediansTotal Median (IQR)Min & max region mediansTotal Median (IQR)Min & max region medians
N37,614 34,132 37,614 36,872 
Age in years6.7 (4.4;8.4)0.7;7.17.4 (5.1;9.1)1.0;7.8Not applicableNot applicable12.4 (11.0;14.4)12.0;16.4
CD4 count in cells/μl430 (205;761) N=19388255.5;1282330 (171;598) N=19368221;1134686 (446;972) N=26282639;797688 (465;948) N=31230578;744
CD4 %16 (9;25) N=1342210;3014 (8;20) N=1456410;2828 (20;34) N=1802926;3329 (21;35) N=2324927;32
Log10 HIV viral load5.00 (4.35;5.58) N=41374.96;5.284.94 (4.16;5.51) N=61674.83;5.102.42 (1.69;3.35) N=101551.69;2.602.30 (1.60;3.18) N=140061.59;2.60
WAZ (<= age 10 years)-1.79 (-2.81;-0.90) N=21,037-2.71;-0.51-1.70 (-2.70;-0.83) N=22,908-2.89;-0.41-1.42 (-2.18;-0.59) N=30,705-1.93;0.09Not applicableNot applicable
HAZ (all ages)-1.92 (-2.91;-0.97) N=20,013-2.37;-0.77-1.98 (-2.94;-1.05) N=19,801-2.44;-0.78-1.54 (-2.36;-0.72) N=26,645-1.91;-0.32-1.60 (-2.46;-0.73) N=32,386-1.78;-0.34
BMIZ (>= age 5 years)-0.60 (-1.54;0.22) N=19892-1.44;0.16-0.56 (-1.46;0.25) N=19,697-1.46;0.20-0.54 (-1.26;0.13) N=26,530-1.00;0.38-0.68 (-1.46;0.09) N=32,295-1.02;0.50
[Table 2: Age, laboratory and anthropometric characteristics of perinatally HIV-infected adolescents (N=37,614) and ranges of medians across regions]

Reported mortality between age 10 and 15 years was 3.08% (95%CI 2.83-3.36) ranging from 0.78% in Europe & Central Asia to 4.72% in South America & Caribbean (Table 1).
Conclusions: Reported mortality during adolescence was < 5% in all regions represented in this global analysis of HIV-infected children surviving to age 10 years. Under-ascertainment of mortality and impaired growth are concerns.