Higher rates of triple‐class virological failure in perinatally <scp>HIV</scp>‐infected teenagers compared with heterosexually infected young adults in Europe

Judd, Ali; Lodwick, R; Noguera-Julián, Antoni; Gibb, Diana M; Butler, Karina; Costagliola, Dominique; Sabin, Caroline; Sighem, Ard van; Ledergerber, Bruno; Torti, Carlo; Mocroft, Amanda; Podzamczer, Daniel; Dorrucci, Maria; Wit, Stéphane De; Obel, Niels; Dabis, François; Cozzi‐Lepri, Alessandro; García, Féderico; Brockmeyer, N. H.; Warszawski, Josiane; González-Tomé, M I; Mussini, Cristina; Touloumi, Giota; Zangerle, Robert; Ghosn, Jade; Castagna, Antonella; Fätkenheuer, Gerd; Stephan, Christoph; Meyer, Laurence; Campbell, M.; Chêne, Geneviève; Phillips, Andrew

doi:10.1111/hiv.12411

Cited by 49 publications

(43 citation statements)

References 20 publications

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“…Nevertheless, transition to adulthood still presents challenges for optimal HIV disease management as adolescent health needs evolve and autonomy for their own self care is necessary [17]. Many of these challenges are shared by both vertically and horizontally infected adolescents, although their disease progression and severity during adolescence may differ [18,19]. To better understand the reasons for poorer outcomes in adolescents compared to other age groups, and the contributions of the transition to adulthood as well as the potential impact of healthcare transition, consensus is needed across settings for both research and surveillance on how to recognize and define when healthcare transition has occurred and ultimately how to identify successful transition through adolescence to adulthood.…”

Section: Introductionmentioning

confidence: 99%

Living and dying to be counted: What we know about the epidemiology of the global adolescent HIV epidemic

Slogrove

Mahy

Armstrong

et al. 2017

Journal of the International AIDS Society

114

101

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Introduction: With increasing survival of vertically HIV‐infected children and ongoing new horizontal HIV infections, the population of adolescents (age 10–19 years) living with HIV is increasing. This review aims to describe the epidemiology of the adolescent HIV epidemic and the ability of national monitoring systems to measure outcomes in HIV‐infected adolescents through the adolescent transition to adulthood.Methods: Differences in global trends between younger (age 10–14 years) and older (age 15–19 years) adolescents in key epidemic indicators are interrogated using 2016 UNAIDS estimates. National population‐based survey data in the 15 highest adolescent HIV burden countries are evaluated and examples of national case‐based surveillance systems described. Finally, we consider the potential impact of adolescent‐specific recommendations in the 2016 WHO Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection.Discussion: UNAIDS estimates indicate the population of adolescents living with HIV is increasing, new HIV infections in older adolescents are declining, and while AIDS‐related deaths are beginning to decline in younger adolescents, they are still increasing in older adolescents. National population‐based surveys provide valuable estimates of HIV prevalence in older adolescents and recent surveys include data on younger adolescents. Only a few countries have nationwide electronic case‐based HIV surveillance, with the ability to provide population‐level data on key HIV outcomes in the diagnosed population living with HIV. However, in the 15 highest adolescent HIV burden countries, there are no systems tracking adolescent transition to adulthood or healthcare transition. The strength of the 2016 WHO adolescent‐specific recommendations on antiretroviral therapy and provision of HIV services to adolescents was hampered by the lack of evidence specific to this age group.Conclusions: Progress is being made in national surveillance and global monitoring systems to specifically identify trends in adolescents living with HIV. However, HIV programmes responsive to the evolving HIV prevention and treatment needs of adolescents can be facilitated further by: data disaggregation to younger and older adolescents and mode of HIV infection where feasible; implementation of tools to achieve expanded national case‐based surveillance; streamlining consent/assent procedures in younger adolescents and consensus on indicators of adolescent healthcare transition and transition to adulthood.

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Section: Introductionmentioning

confidence: 99%

Living and dying to be counted: What we know about the epidemiology of the global adolescent HIV epidemic

Slogrove

Mahy

Armstrong

et al. 2017

Journal of the International AIDS Society

114

101

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“…The HIV Research Network based in the USA reported that 20% of youth aged 21 years receiving HIV care were lost to follow-up within one year [16]. In the UK and Europe, studies of young people with perinatal HIV suggest similarly poor outcomes, with increased risk of mortality [17], care disengagement [18], and treatment failure [19,20]. …”

Section: Introductionmentioning

confidence: 99%

Growing up with perinatal HIV: changes in clinical outcomes before and after transfer to adult care in the UK

Judd

Collins

Parrott

et al. 2017

Journal of the International AIDS Society

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Introduction: With improved survival, adolescents with perinatal HIV (PHIV) are transitioning from paediatric to adult care, but there are few published data on clinical outcomes post-transfer. Using linked data from patients in the national UK/Ireland paediatric cohort (CHIPS) and an adult UK cohort of outpatient clinics (UK CHIC), we describe mortality and changes in immunological status post-transfer.Methods: Participants in CHIPS aged ≥13 years by the end of 2013 were linked to the UK CHIC database. Mixed effects models explored changes in CD4 count before and after transfer, including interactions between time and variables where interaction p < 0.05.Results: Of 1,215 paediatric participants aged ≥13 years, 271 (22%) had linked data in UK CHIC. One hundred and forty-six (53%) were female, median age at last visit in paediatric care was 17 [interquartile range, IQR 16,18] years, median duration in paediatric care was 11.8 [6.6,15.5] years, and in adult care was 2.9 [1.5,5.9] years. At last visit in paediatric care, 74% (n = 200) were on ART, increasing to 84% (n = 228, p = 0.001) at last visit in adult care. In the 12 months before leaving paediatric care, 92 (47%) had two consecutive viral loads >400 copies/mL or one viral load >10,000 copies/mL, and likewise 102 (52%) in the 12 months post-transfer (p = 0.79). Seven (3%) people died in adult care. In multivariable analysis, CD4 declined as patients approached transition with a greater decline in those with higher nadir CD4 count (mean rates of decline of 3, 13, 15, 30 cells/mm3 per year for those with nadir CD4 < 100, 100–199, 200–299 and ≥300 cells/mm3, respectively). Post-transition, CD4 continued to decline in some groups (e.g. black males, −20 (−34, −5) cells/mm3 per year post transition, p = 0.007)) while it improved in others. Overall CD4 was higher with later year of birth (14 (7, 21) cells/mm3 per later year). There was no effect of age at transfer or changing hospital at transfer on CD4.Conclusions: Our findings suggest that CD4 in adolescents with perinatal HIV in the UK was declining in the period before transition to adult care, and there was some reversal in this trend post-transfer in some groups. Across the transition period, CD4 was higher in those with later birth years, suggesting improvements in clinical care and/or transition planning over time.

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“…(1) Chi2 test (2) Fisher's exact test (3) Wilcoxon-Mann-Whitney test (1) Chi2 test; (2) Fisher's exact test; (3) Wilcoxon-Mann-Whitney test †More than 95% of planned doses taken. 15 [13][14][15][16][17] 16 [14][15][16][17][18] 13 [12-(1) Chi2 test; (2) Fisher's exact test; (3) Wilcoxon-Mann-Whitney test Flow chart of inclusion of 209 APHIV in the COHADO Cohort, IeDEA-pWADA, 2015.…”

Section: Availability Of Data and Materialsmentioning

confidence: 99%

“…Since 2015, universal ART is recommended by WHO [13]. Compared to adults or younger children, adolescent living with perinatally acquired HIV (APHIV) experience higher morbidity, mortality and lower rates of virological suppression on ART [3,[14][15][16]. This is most likely related to delayed access to HIV diagnosis and ART in childhood, lack of timely HIV-disclosure while growing-up, with poor medication adherence in a context of prolonged ART, poor retention in care, explained by individual, social, and structural barriers [6,[17][18][19][20][21].…”

Section: Introductionmentioning

confidence: 99%

24-month clinical, immuno-virological outcomes and HIV status disclosure in adolescents living with perinatally-acquired HIV in the COHADO cohort, in Togo and Côte d’Ivoire, 2015-2017

Revegue

Takassi

Eboua

et al. 2020

Preprint

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Background: Adolescents living with perinatally-acquired HIV (APHIV) face challenges including timely disclosure of their HIV-serostatus that was explored in the West-African COHADO cohort. We assessed the 24-month outcomes in COHADO, among APHIV in relation to the disclosure of their own HIV-serostatus. Methods: Nested within the International epidemiologic Database to Evaluate AIDS pediatric West African prospective cohort (IeDEA pWADA), the COHADO cohort included antiretroviral (ART)-treated APHIV aged 10–19 years, enrolled in HIV-care <10 years, in Abidjan (Côte d’Ivoire) and Lomé (Togo) in 2015. A favorable 24-month outcome was defined when combining being retained in care, without progression to WHO-AIDS stage, with CD4 cell count > baseline CD4 (± 10%) and with virological suppression (viral load [VL] <50 copies/mL). We investigated correlates of APHIV favorable 24-month outcome using multivariate logistic regression. Results: Overall, 209 APHIV were included, 51.6% in Abidjan, 54.5% were females. At inclusion, median CD4 cell count was 521/mm3 (IQR[281-757]); only 29.6% had a VL measurement of whom 3.2% in virological suppression. APHIV were younger in Lomé (median age: 12 years (interquartile range [IQR]:11-15) compared to Abidjan (14 years (IQR:12-15, p=0.01). Full HIV-disclosure increased from 41.6% at inclusion to 74.1% after 24 months. After 24 months of follow-up, 6 (2.9%) died, 8 (3.8%) were lost to follow-up, 4 (1.9%) were transferred out. Overall, 73.7% did not progress to WHO-AIDS stage, 62.7% had CD4 count above (± 10%) of the baseline value (48.6% in Abidjan versus 69.0% in Lomé, p<0.001). Among the 83.7% with VL measurements, 48.8% were in virological suppression (Abidjan: 45.4%, Lomé: 52.5%, p<0.01). The 24-month combined outcome was favorable for 45% (29.6% in Abidjan and 61.4% in Lomé, p<0.01). Adjusted on sex, age, a 24-month favorable outcome was not associated with HIV-disclosure status but was significantly higher for APHIV living in Lomé compared to those living Abidjan (adjusted odds ratio =4.41, 95%CI:2.29-8.50). Conclusions: 24-month favorable outcome rates were low among West-African APHIV and differed accross countries. HIV-disclosure frequency improved over time but remained low. Context-specific responses are urgently needed to improve adolescent’s care to reach the UNAIDS 90% target of virological success for those on ART.

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Higher rates of triple‐class virological failure in perinatally HIV‐infected teenagers compared with heterosexually infected young adults in Europe

Cited by 49 publications

References 20 publications

Living and dying to be counted: What we know about the epidemiology of the global adolescent HIV epidemic

Living and dying to be counted: What we know about the epidemiology of the global adolescent HIV epidemic

Growing up with perinatal HIV: changes in clinical outcomes before and after transfer to adult care in the UK

24-month clinical, immuno-virological outcomes and HIV status disclosure in adolescents living with perinatally-acquired HIV in the COHADO cohort, in Togo and Côte d’Ivoire, 2015-2017

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