Characterizing HIV Manifestations and Treatment Outcomes of Perinatally Infected Adolescents in Asia

Abstract

Background More perinatally HIV-infected children in Asia are reaching adolescence. Methods We analyzed data from July 1991 to March 2011 reported by 18 clinics in six countries of children age >12 years. Results Of 1,254 adolescents, 33 (2.6%) died, and 52 (4.2%) were lost to follow-up within 2.4-year (3566 person-years) median follow-up period. Of 1,061 adolescents under active follow-up, 485 (46%) were male, median (IQR) age was 14.7 (13.3-16.4) years, 73% had lost a parent(s), 93% attended school, and 62% were aware of their HIV status. At the most recent evaluation, 93% were receiving highly active antiretroviral therapy (ART), 71% (N=737/1035) had CD4 >500 cells/mm3 and 86% (N=718/830) had viral load (VL) <400 copies/mL. Current CD4 >200 cells/mm3, no previous WHO stage 3 or 4, and being on a first-line regimen were independently associated with recent VL <400 copies/mL. Current age <15 years, VL <400 copies/ml, CD4 15-24% (vs. <10%) at ART initiation, no previous WHO stage 3 or 4, and ART duration of >1 year were associated with recent CD4 >500 cells/mm3.Primary causes of death after age 12 were opportunistic infections (N=15/33) and other AIDS- or treatment-related conditions (N=9/33). Those at age 12 with CD4 <200 vs. >500 cells/mm3 and those with VL >10,000 vs. <10,000 copies/mL were 17.4 and 4.76 times more likely to die in adolescence, respectively. Conclusion Adolescents in this cohort have been successfully maintained in HIV care. Initiating treatment at earlier stages of disease was associated with immune recovery and virologic suppression during adolescence.

Anthropometric Improvement among HIV Infected Pre-School Children Following Initiation of First Line Anti-Retroviral Therapy: Implications for Follow Up

“…Congruent with other studies which assessed immunologic recovery in children [25–27], our findings also show that there is a positive relation between anthropometric indices and immunologic recovery at follow up. Specifically, the HAZ at both ART initiation and follow up was found to be positively correlated with the CD4 percentage at follow up.…”

“…Specifically, the HAZ at both ART initiation and follow up was found to be positively correlated with the CD4 percentage at follow up. Similar reports have been published thus far for adults and older children [25, 28, 29]. …”

Adolescents with HIV and transition to adult care in the Caribbean, Central America and South America, Eastern Europe and Asia and Pacific regions

“…The TREAT Asia Pediatric HIV Observational Database (TApHOD) is a regional database including more than 4000 HIV-infected children and adolescents in Thailand, Cambodia, Malaysia, India, Indonesia and Vietnam. A report from the TApHOD database in 2011, at a time when one-third of children in the cohort were older than 12 years, showed that more than two-thirds of adolescents had lost at least one parent and the majority were cared for by grandparents or relatives [52]. Countries with the largest number of adolescents living with HIV in the region are India, Indonesia, Thailand, Myanmar, and Vietnam.…”

Non-Nucleoside Reverse Transcriptase Inhibitor–Based Antiretroviral Therapy in Perinatally HIV-Infected, Treatment-Naïve Adolescents in Asia

“…Numerous adult and pediatric studies support these results,[12,30,33] including the recent START study which was terminated ahead of schedule after the interim analysis revealed that delaying ART initiation in asymptomatic adults until CD4+ cell count drops to 350 cells/mm 3 significantly increased the risk of an AIDS-related event, serious non-AIDS-related event, or death. [33] Although the PREDICT trial reported no difference in AIDS-free survival between early and deferred ART in children older than 1 year of age, the authors themselves concluded that the lower than expected event rate in their study resulted in their analysis being underpowered to detect a significant difference.…”

“…[9] In comparison, data from Asia, including our own, indicate that HIV-infected adolescents in the region have a better immune response to ART and lower rates of attrition and death. [30–32] Importantly, these differences do not appear to be attributable to regional variation in adherence as a recent meta-analysis reported that adolescents in Africa and Asia both exhibit an average ART adherence of approximately 84%. [10] The findings from our study suggest that an alternative explanation might be regional variation in the timing of ART initiation and use of cotrimoxazole prophylaxis.…”