Hospitalization in South African Adolescents With Perinatally Acquired HIV on Antiretroviral Therapy

Abstract

Background-Little is known about hospitalization in African adolescents with perinatally acquired HIV (PHIV+ adolescents). We described the incidence and causes of hospitalization in participants enrolled in the Cape Town Adolescent Antiretroviral Cohort in South Africa.Methods: Data collected from July 2013 through October 2018 from PHIV+ and HIV− adolescents were analyzed. Participants were assessed every six months and data on intercurrent hospitalization were abstracted. Causes of hospitalizations were classified according to ICD-10 codes. Descriptive statistics, time-to-event analysis and Poisson regression were used to describe causes and incidence and to determine incidence rate ratios for factors associated with hospitalization.Results: 515 PHIV+ and 109 HIV− participants had a median follow up of 4.1 years (IQR: 3.7-4.6). At enrollment HIV+ participants had a median duration of ART of 7.6 years (IQR:4.6-9.2), median CD4 count of 713 cells/mm 3 (IQR: 561.0-957.5) and 387 (75%) had a viral load <50 copies/ml. There were 149 hospital admissions over 64-months. Crude incidence rates for hospitalization were 6.6 (95%CI: 5.7-7.8) and 2.2 (95%CI:1.2-4.3) per 100-person years (p=<0.01) in HIV + and HIV− respectively.Ninety of 149 (60%) admissions in HIV+ participants were classified as non-infectious, 36/149 (24%) were infectious, and 23/149 (16%) were 'other HIV-related' or 'unknown'. Older age (15-19 years) and maintaining a CD4>500 cells/cm 3 were associated with decreased risk of hospitalization: adjusted incidence rate ratios of 0.61 (CI: 0.44-0.86, p=<0.01) and 0.68 (CI: 0.49-0.94, p=0.02), respectively.

Self-transfers, Hospital Admissions and Mortality Among Children and Adolescents Lost to Follow-up From Antiretroviral Therapy Programs in the Western Cape, South Africa Between 2004 and 2019: Linkage to Provincial Records

“…Hospitalization was higher in males than females and significantly shifted to adolescents, with a 5-fold higher risk in those older than 15 years. Conversely, Frigati et al 19 found no association between hospitalization and sex. They found that older adolescents had a lower incidence rate of hospitalization than younger adolescents in South African adolescents.…”

“…While hospitalization among adolescents may indicate poorer treatment adherence and increased AIDS-related morbidity, it also includes non-AIDS-related admissions like violence exposure, traffic accidents, mental health issues and pregnancies, highlighting the need to strengthen adolescent care holistically. 19 In South Africa, young boys and men have a 3-fold higher level of violence exposure than girls. 20 While we did not have data on admission reasons, Dicko et al 18 reported that 62% of hospitalizations in children with HIV in West Africa were AIDS-related.…”

“…High adolescent hospitalization rates may result from unique developmental, behavioral, psychosocial, and infrastructural factors necessitating tailored approaches to support them to optimize their treatment outcomes. 21 A study conducted by Frigati et al, 19 examining hospitalization rates among adolescents living with perinatally acquired HIV juxtaposed with those without HIV found that there were higher hospitalizations among adolescents with perinatally acquired HIV in comparison to their counterparts. However, only 11% of these admissions were HIV-related.…”

Treatment Non-Adherence or Abandonment Among Adolescents and Young Individuals Living with HIV/AIDS: A Scoping Review

“…Even so, one of the reasons for hospitalization among adolescents and young people can be related to untreated HIV/AIDS, which consequently increases the cases of repeated infections. The age group between 10 and 24 has the highest follow-up loss rates and worst virological results (40). It is essential to highlight that, in addition to demographic and clinical factors, socioeconomic disadvantages, social circumstances, mental health disorders and adverse lifestyles are also factors for hospitalization (41).…”

Hospitalization among infants who initiate antiretroviral therapy before 3 months of age

“…Despite improvements in morbidity and mortality of children with HIV [13,14], frequency of hospital admissions and mortality during hospitalizations remain a concern [15][16][17][18]. Existing literature mostly describes hospitalization patterns among older children [19][20][21][22], tends to focus largely on cause-specific hospitalizations [23,24], and assesses time periods before the introduction of universal ART access [25][26][27]. This study aims to describe hospitalization patterns and examine factors associated with hospitalization among infants with HIV in the era of universal birth testing and universal ART in South Africa.…”