Characteristics, mortality and outcomes at transition for adolescents with perinatal HIV infection in Asia

• Main Authors: Adam W. Bartlett, Khan Huu Truong, Wipaporn Natalie Songtaweesin, Kulkanya Chokephaibulkit, Rawiwan Hansudewechakul, Penh Sun Ly, Pagakrong Lumbiganon, Tavitiya Sudjaritruk, Lam Van Nguyen, Viet Chau Do, Nagalingeswaran Kumarasamy, Nik Khairulddin Nik Yusoff, Nia Kurniati, Moy Siew Fong, Dewi Kumara Wati, Revathy Nallusamy, Annette H. Sohn, Matthew G. Law, Thahira Jamal Mohamed
• Format: Journal
• Published: 2018
• Subjects: Immunology and Microbiology; Medicine
• Online Access: https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85056582448&origin=inward; http://cmuir.cmu.ac.th/jspui/handle/6653943832/62748
• Institution: Chiang Mai University

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved. 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% hadCD4+ cell count less than 500 cells/ml and 51.1% had experience da WHO stage III/IV clinical event. At transition, 38.9% had CD4+ cell count less than 500copies/ml, and 53.4% had experienced a WHO stage III/IV clinical event. Mortality ratewas 0.71 per 100 person-years, with HIV RNA >1000copies/ml, CD4+ cell count less than 500cells/ml, height-for-ageorweight-for-agez-score less than - 2, historyofa 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.