Long-term trends in mortality and AIDS-defining events after combination ART initiation among children and adolescents with perinatal HIV infection in 17 middle- and high-income countries in Europe and Thailand: A cohort study

Judd, Ali; Chappell, Elizabeth; Turkova, Anna; Cœur, Sophie Le; Noguera-Julián, Antoni; Goetghebuer, Tessa; Doerholt, Katja; Galli, Luisa; Pajkrt, Dasja; Marquès, Laura; Collins, Intira Jeannie; Gibb, Diana M; Tomé, María Isabel González; Navarro, Marisa; Warszawski, Josiane; Königs, Christoph; Spoulou, Vana; Prata, Filipa; Chiappini, Elena; Navér, Lars; Giaquinto, Carlo; Thorne, Claire; Marczyńska, Magdalena; Okhonskaia, Liubov; Posfay-Barbe, Klara; Ounchanum, Pradthana; Techakunakorn, Pornchai; Kiseleva, G.P.; Malyuta, Ruslan; Volokha, Alla; Ene, Luminiţa; Goodall, Ruth

doi:10.1371/journal.pmed.1002491

Cited by 33 publications

(28 citation statements)

References 26 publications

(27 reference statements)

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“…From our regression model, most factors found to be protective against death among those who started treatment with triple‐drug ART were consistent with other studies (e.g. better immune control, higher weight‐for‐age z‐score) . Any CD4 category ≥200 cells/mm 3 or weight‐for‐age z‐score better than or equal to −3 was highly protective; as was starting triple‐drug ART after 2011, which may reflect scale‐up and quality improvement of paediatric HIV programmes and broadening treatment access in our settings .…”

Section: Discussionsupporting

confidence: 87%

Mortality and losses to follow‐up among adolescents living with HIV in the IeDEA global cohort collaboration

et al. 2018

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IntroductionWe assessed mortality and losses to follow‐up (LTFU) during adolescence in routine care settings in the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium.MethodsCohorts in the Asia‐Pacific, the Caribbean, Central, and South America, and sub‐Saharan Africa (Central, East, Southern, West) contributed data, and included adolescents living with HIV (ALHIV) enrolled from January 2003 and aged 10 to 19 years (period of adolescence) while under care up to database closure (June 2016). Follow‐up started at age 10 years or the first clinic visit, whichever was later. Entering care at <15 years was a proxy for perinatal infection, while entering care ≥15 years represented infection acquired during adolescence. Competing risk regression was used to assess associations with death and LTFU among those ever receiving triple‐drug antiretroviral therapy (triple‐ART).ResultsOf the 61,242 ALHIV from 270 clinics in 34 countries included in the analysis, 69% (n = 42,138) entered care <15 years of age (53% female), and 31% (n = 19,104) entered care ≥15 years (81% female). During adolescence, 3.9% died, 30% were LTFU and 8.1% were transferred. For those with infection acquired perinatally versus during adolescence, the four‐year cumulative incidences of mortality were 3.9% versus 5.4% and of LTFU were 26% versus 69% respectively (both p < 0.001). Overall, there were higher hazards of death for females (adjusted sub‐hazard ratio (asHR) 1.19, 95% confidence interval (CI) 1.07 to 1.33), and those starting treatment at ≥5 years of age (highest asHR for age ≥15: 8.72, 95% CI 5.85 to 13.02), and in care in mostly urban (asHR 1.40, 95% CI 1.13 to 1.75) and mostly rural settings (asHR 1.39, 95% CI 1.03 to 1.87) compared to urban settings. Overall, higher hazards of LTFU were observed among females (asHR 1.12, 95% CI 1.07 to 1.17), and those starting treatment at age ≥5 years (highest asHR for age ≥15: 11.11, 95% CI 9.86 to 12.53), in care at district hospitals (asHR 1.27, 95% CI 1.18 to 1.37) or in rural settings (asHR 1.21, 95% CI 1.13 to 1.29), and starting triple‐ART after 2006 (highest asHR for 2011 to 2016 1.84, 95% CI 1.71 to 1.99).ConclusionsBoth mortality and LTFU were worse among those entering care at ≥15 years. ALHIV should be evaluated apart from younger children and adults to identify population‐specific reasons for death and LTFU.

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Section: Discussionsupporting

confidence: 87%

Mortality and losses to follow‐up among adolescents living with HIV in the IeDEA global cohort collaboration

et al. 2018

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“…Among YPHIV, 3% died and the overall estimated mortality rate was 0.7/100 person-years, which was comparable in men and women. Similar rates have been reported in other cohorts of adolescents living with HIV across sub-Saharan Africa as well as in high-income countries [ 15 – 18 ]. However, in high-income countries, youth were in general older than our cohort, where the 10–19 years strata primarily drive the results and little person time was spent in the age 20–24 stratum.…”

Section: Discussionsupporting

confidence: 86%

Age-specific mortality rate ratios in adolescents and youth aged 10–24 years living with perinatally versus nonperinatally acquired HIV

Desmonde

Ciaranello

Malateste

et al. 2020

Aids

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Objective: To measure mortality incidence rates and incidence rate ratios (IRR) in adolescents and youth living with perinatally acquired HIV (YPHIV) compared with those living with nonperinatally acquired HIV (YNPHIV), by region, by sex, and during the ages of 10–14, 15–19, and 20–24 years in IeDEA. Design and methods: All those with a confirmed HIV diagnosis, antiretroviral therapy (ART)-naive at enrollment, and who have post-ART follow-up while aged 10–24 years between 2004 and 2016 were included. We estimated post-ART mortality incidence rates and 95% confidence intervals (95% CI) per 100 person-years for YPHIV (enrolled into care <10 years of age) and YNPHIV (enrolled ≥10 years and <25 years). We estimate mortality IRRs in a negative binomial regression model, adjusted for sex, region time-varying age, CD4 + cell count at ART initiation (<350 cells/μl, ≥350 cells/μl, unknown), and time on ART (<12 and ≥12 months). Results: Overall, 104 846 adolescents and youth were included: 21 340 (20%) YPHIV (50% women) and 83 506 YNPHIV (80% women). Overall mortality incidence ratios were higher among YNPHIV (incidence ratio: 2.3/100 person-years; 95% CI: 2.2–2.4) compared with YPHIV (incidence ratio: 0.7/100 person-years; 95% CI: 0.7–0.8). Among adolescents aged 10–19 years, mortality was lower among YPHIV compared with YNPHIV (all IRRs <1, ranging from 0.26, 95% CI: 0.13–0.49 in 10–14-year-old boys in the Asia-Pacific to 0.51, 95% CI: 0.30–0.87 in 15–19-year-old boys in West Africa). Conclusion: We report substantial amount of deaths occurring during adolescence. Mortality was significantly higher among YNPHIV compared to YPHIV. Specific interventions including HIV testing and early engagement in care are urgently needed to improve survival among YNPHIV.

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“…Data from the EPPICC Paediatric merger 2014 ( n = 3953) were used, as described previously [23,24]. In brief, the EPPICC merged individual patient data on routine demographic, clinical, laboratory and treatment-related variables from 19 observational cohorts across 17 countries prepared according to a standardised data specification.…”

Section: Methodsmentioning

confidence: 99%

Predictors of faster virological suppression in early treated infants with perinatal HIV from Europe and Thailand

2019

Aids

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Long-term trends in mortality and AIDS-defining events after combination ART initiation among children and adolescents with perinatal HIV infection in 17 middle- and high-income countries in Europe and Thailand: A cohort study

Abstract: Background

Cited by 33 publications

References 26 publications

Mortality and losses to follow‐up among adolescents living with HIV in the IeDEA global cohort collaboration

Mortality and losses to follow‐up among adolescents living with HIV in the IeDEA global cohort collaboration

Age-specific mortality rate ratios in adolescents and youth aged 10–24 years living with perinatally versus nonperinatally acquired HIV

Predictors of faster virological suppression in early treated infants with perinatal HIV from Europe and Thailand

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