Long‐Term Outcomes in Adolescents Perinatally Infected with HIV‐1 and Followed Up since Birth in the French Perinatal Cohort (EPF/ANRS CO10)

Abstract

BACKGROUND. Increasing numbers of children perinatally infected with human immunodeficiency virus (HIV) are reaching adolescence, largely because of advances in treatment over the past 10 years, but little is known about their current health status. We describe here the living conditions and clinical and immunovirologic outcomes at last evaluation among this pioneering generation of adolescents who were born before the introduction of prophylaxis for vertical transmission and whose infections were diagnosed at a time when treatment options were limited. METHODS. The eligible population consisted of HIV-1-infected children who were born before December 1993 and who were included at birth in the prospective national French Perinatal Cohort (EPF/ANRS CO10). RESULTS. Of the 348 eligible children, 210 (60%; median age, 15 years) were still alive and regularly followed up. Current treatment was highly active antiretroviral therapy (HAART) in 77% and 2 nucleoside analogues in 5.0%; 16% had stopped treatment, and 2% had never been treated. The median CD4 cell count was 557 cells/microL, and 200 cells/microL was exceeded in 94% of patients. The median viral load was 200 copies/mL. Viral load was undetectable in 43% of the adolescents and in 54.5% of those receiving HAART. Median height, weight, and body mass index were similar to French reference values for age, and school achievement was similar to nationwide statistics. Better immunologic status was associated with being younger and with having begun HAART earlier. Undetectable viral load was associated with maternal geographic origin and current HAART. CONCLUSIONS. Given the limited therapeutic options available during the early years of these patients' lives and the challenge presented by treatment adherence during adolescence, the long-term outcomes among this population are encouraging.

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

“…There can also be issues of coming to terms with their own HIV status, secrecy and guilt among other family members, and dealing with HIV infection in the context of the adolescent transitional stage of development 11, 12. Once ART has been started, studies have found lower rates of viral suppression in young people with perinatal HIV infection compared with adults 13, which are probably attributable to adherence issues and poor clinic attendance rather than drug efficacy, both common problems among young adults living with other chronic diseases 1, 14, 15, 16. Findings from this study support the benefit of earlier age at diagnosis where possible, and initiation of ART prior to the adolescent period, which will probably also favour improved immunological health 17.…”

Focus on adolescents with HIV and AIDS

“…[5] Reductions in mortality rates of up to 76% in PHIV children and adolescents receiving ART have been reported in well-resourced settings. [6] All-cause mortality rates are similar when adolescents (9 -19 years) and young adults receiving ART (20 -29 years) are compared in reports from sub-Saharan Africa.…”

Perinatally infected adolescents living with human immunodeficiency virus (perinatally human immunodeficiency virus)

“…Several studies have shown that the proportion of PHIV adolescents with viral suppression is approximately 50% [56][57][58][59] . The possible transmission of virus strains with resistanceassociated mutations by this population to their sexual partners is a significant cause of concern.…”