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

Bartlett, Adam W.; Truong, K. H.; Songtaweesin, Wipaporn Natalie; Chokephaibulkit, Kulkanya; Hansudewechakul, Rawiwan; Ly, Penh Sun; Lumbiganon, Pagakrong; Sudjaritruk, Tavitiya; Nguyen, Lam Van; Chau, Viet; Kumarasamy, Nagalingeswaran; Yusoff, Nik Khairulddin Nik; Kurniati, Nia; Fong, Moy Siew; Wati, Dewi Kumara; Nallusamy, Revathy; Sohn, Annette H.; Law, Matthew; Mohamed, Thahira Jamal

doi:10.1097/qad.0000000000001883

Cited by 8 publications

(9 citation statements)

References 25 publications

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“…Based on the current study findings, late HIV diagnosis in older ages, in stages 3 or 4, or with a lower CD4 count could significantly increase the risk of ARM. These results were in line with the findings of other studies [36, 37]. The results regarding NARM indicated that the male patients in earlier stages and those who had a history of incarceration, also had a significantly shorter survival time.…”

Section: Discussionsupporting

confidence: 92%

Determinants of AIDS and non-AIDS related mortality among people living with HIV in Shiraz, southern Iran: a 20-year retrospective follow-up study

et al. 2019

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BackgroundHuman Immunodeficiency Virus (HIV) infection has become a global concern. Determining the factors leading to death among HIV patients helps controlling Acquired Immune Deficiency Syndrome (AIDS) epidemic. Up to now, little is known about mortality and its determinants among people living with HIV in the Middle East and North Africa (MENA) region, including Iran. The purpose of this study was to assess the risk factors of AIDS-Related Mortality (ARM) and Non-AIDS-Related Mortality (NARM) among people with HIV in Iran.MethodsThis 20-year retrospective study was conducted on 1160 people with HIV whose data were collected from 1997 to 2017. The association of the study outcomes (ARM and NARM) with various study variables, including demographic status at the time of diagnosis and clinical indexes during the follow-up were examined to define the predictors of mortality among the patients. Regarding, Cox proportional hazard and competing risk models were fitted and Adjusted Hazard Ratios (AHR), Sub-distribution Hazard Ratio (SHR) and the 95% Confidence Intervals (CI) were reported.Resultsduring the follow-up period, 391 individuals (33.7%) died with 86,375 person-years of follow-up. Of the total deaths, 251 (64.2%) and 140 (35.8%) were ARM and NARM, respectively. Rates of the mortality caused by AIDS and non-AIDS were 3.2 and 4.5 per 1000 person-months, respectively. Responding to combined Antiretroviral Treatment (cART) 6 months after initiation, receiving Pneumocystis Pneumonia (PCP) prophylaxis, and higher CD4 count at diagnosis, reduced the hazard of ARM and NARM. However, older age, late HIV diagnosis, and last HIV clinical stages increased the hazard of AIDS related to mortality. Additionally, male gender, older age, incarceration history, and last HIV clinical stages increased the non-AIDS mortality.ConclusionsMortality caused by AIDS and non-AIDS remains high among people with HIV in Iran, particularly among males and those with late diagnosis. It seems that applying effective strategies to identify infected individuals at earlier stage of the infection, and targeting individuals with higher risk of mortality can decrease the mortality rate among HIV infected people.

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Section: Discussionsupporting

confidence: 92%

Determinants of AIDS and non-AIDS related mortality among people living with HIV in Shiraz, southern Iran: a 20-year retrospective follow-up study

et al. 2019

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“…[7][8][9][10][11] The common risk factors for mortality were a low CD4 percentage, WHO clinical stage 3 or 4 and malnutrition. [8][9][10]12 In a cohort of 266 HIV-infected children with suspected tuberculosis (TB) in four countries (Burkina Faso, Cambodia, Cameroon, and Vietnam), Marcy et al found that TB, young age, CD4 less than 10%, miliary features, and elevated serum transaminases were all independent predictors of mortality. 13 In Vietnam, by the end of 2011, there were 3200 Vietnamese children with HIV/AIDS receiving ART; However, there were a few reports on ART outcomes among HIV-infected children [14][15][16] In a study of 86 children on ART in Hanoi, Vietnam, Pham et al reported that the success rate (plasma HIV-1 viral load <1000 copies/mL) was 79.1% after 2-year follow-up.…”

Section: Introductionmentioning

confidence: 99%

<p>Long-Term Outcomes and Risk Factors for Mortality in a Cohort of HIV-Infected Children Receiving Antiretroviral Therapy in Vietnam</p>

Nguyen¹,

Ton²,

Luong³

et al. 2020

HIV

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Background: Management of HIV-infected children on a long-term basis is a challenge in resource-limited countries. The aim of this study is to evaluate the long-term outcome and identify the risk factors for mortality in a cohort of children with antiretroviral therapy (ART) in Vietnam. Patients and Methods: A retrospective cohort study was conducted in children aged 0-15 years, seen at the outpatient clinic of the Women and Children Hospital of An Giang, Vietnam, from August 2006 to May 2019. Cox proportional-hazard models were used to determine factors associated with mortality. Results: A total of 266 HIV-infected children were on ART. During 1545 child-years of follow-up (median follow-up was 5.8 years), 28 (10.5%) children died yielding a mortality rate of 1.8 death per 100 child-years. By multivariate analysis, World Health Organization clinical stage 3 or 4 (AHR; 7.86, 95% CI; 1.02-60.3, P= 0.047), tuberculosis (TB) coinfection (AHR; 6.26, 95% CI; 2.50-15.64, P= 0.001) and having severe immunosuppression before ART (AHR; 11.73, 95% CI; 1.52-90.4, P= 0.018) were independent factors for mortality in these children. Conclusion: Antiretroviral therapy has reduced mortality in HIV-infected children in resource-limited settings. Independent risk factors for mortality were advanced clinical stage (3 or 4), TB co-infection and severe immunosuppression. Early investigation and treatment of TB co-infection allow early ART initiation which may improve outcomes in our settings.

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“…The technical and pharmacokinetic complexities related to development of formulations that are safe, palatable and allow dosing across various ages and weight is challenging, requiring extensive research. Furthermore, outdated procurement practices and gaps in supply chains, delay in regulatory approvals at an individual country level, and stagnant government policies can result in further delay in uptake of new ART into treatment programs [11,12].…”

Section: Antiretroviral Therapy Challenges In Children and Adolescentsmentioning

confidence: 99%

“…Adolescence is a period of dramatic neurocognitive and physiological change and often includes experimentation with sexual behaviour, alcohol and recreational drug use. Furthermore, there is a decrease in the engagement of health care services that may influence adherence [12,30]. The rising mortality for older adolescents (15-19 years) living with HIV has been attributed to complex challenges with ART adherence and poor retention in care [30].…”

Section: Barriers To Antiretroviral Therapy Among Adolescents Living mentioning

confidence: 99%

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Immune Dysfunction and Antiretroviral Therapy Challenges in Children and Adolescents Living with Human Immunodeficiency Virus

Said¹,

Bartlett²

2021

Innate Immunity in Health and Disease

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Human immunodeficiency virus (HIV) infection results in progressive decline in immune function ultimately leading to acquired immunodeficiency syndrome (AIDS) characterised by increased susceptibility to opportunistic infections and malignancies. In addition, it causes immune dysfunction, which manifests as a persistent inflammatory state due to dysregulation of cytokine production. Antiretroviral therapy (ART) not only improves immune function but also mitigates systemic immune activation associated with disease progression. Early initiation of ART in children living with HIV has led to a growing cohort surviving into adolescence and beyond. As such, they will experience lifelong exposure to an array of physiologic processes associated with systemic infection, immune dysfunction and antiretroviral medications. This leaves them not only susceptible to a range of morbidities associated with chronic inflammation, immune dysregulation, and drug toxicity but also vulnerable to treatment fatigue leading to issues with treatment adherence and engagement in care. Children experience additional barriers to maintaining suppressive ART due to limited paediatric-friendly formulations that are palatable and contribute to regimen complexity. Tolerability and durability of long-term ART are integral in optimising outcomes for children and adolescents living with HIV and maximising viability of future ART regimens throughout adulthood.

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

Cited by 8 publications

References 25 publications

Determinants of AIDS and non-AIDS related mortality among people living with HIV in Shiraz, southern Iran: a 20-year retrospective follow-up study

Determinants of AIDS and non-AIDS related mortality among people living with HIV in Shiraz, southern Iran: a 20-year retrospective follow-up study

<p>Long-Term Outcomes and Risk Factors for Mortality in a Cohort of HIV-Infected Children Receiving Antiretroviral Therapy in Vietnam</p>

Immune Dysfunction and Antiretroviral Therapy Challenges in Children and Adolescents Living with Human Immunodeficiency Virus

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