Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2018 Jul 31;32(12):1689-1697.
doi: 10.1097/QAD.0000000000001883.

Characteristics, mortality and outcomes at transition for adolescents with perinatal HIV infection in Asia

Adam W Bartlett  1 , Khan Huu Truong  2 , Wipaporn Natalie Songtaweesin  3 , Kulkanya Chokephaibulkit  4 , Rawiwan Hansudewechakul  5 , Penh Sun Ly  6 , Pagakrong Lumbiganon  7 , Tavitiya Sudjaritruk  8 , Lam Van Nguyen  9 , Viet Chau Do  10 , Nagalingeswaran Kumarasamy  11 , Nik Khairulddin Nik Yusoff  12 , Nia Kurniati  13 , Moy Siew Fong  14 , Dewi Kumara Wati  15 , Revathy Nallusamy  16 , Annette H Sohn  17 , Matthew G Law  1 , Thahira Jamal Mohamed  18
Affiliations
Observational Study

Characteristics, mortality and outcomes at transition for adolescents with perinatal HIV infection in Asia

Adam W Bartlett et al. AIDS. .

Abstract

Objectives: The aim of this study was to describe characteristics of perinatally HIV-infected adolescents (PHIVAs), factors associated with mortality, and outcomes at transition.

Design: Ongoing observational database collating clinical data on HIV-infected children and adolescents in Asia.

Methods: Data from 2001 to 2016 relating to adolescents (10-19 years) with perinatal HIV infection were analysed to describe characteristics at adolescent entry and transition and combination antiretroviral therapy (cART) regimens across adolescence. A competing risk regression analysis was used to determine characteristics at adolescent entry associated with mortality. Outcomes at transition were compared on the basis of age at cART initiation.

Results: Of 3448 PHIVA, 644 had reached transition. Median age at HIV diagnosis was 5.5 years, cART initiation 7.2 years and transition 17.9 years. At adolescent entry, 35.0% had CD4+ cell count less than 500 cells/μl and 51.1% had experienced a WHO stage III/IV clinical event. At transition, 38.9% had CD4+ cell count less than 500 copies/ml, and 53.4% had experienced a WHO stage III/IV clinical event. Mortality rate was 0.71 per 100 person-years, with HIV RNA ≥1000 copies/ml, CD4+ cell count less than 500 cells/μl, height-for-age or weight-for-age z-score less than -2, history of a WHO stage III/IV clinical event or hospitalization and at least second cART associated with mortality. For transitioning PHIVA, those who commenced cART age less than 5 years had better virologic and immunologic outcomes, though were more likely to be on at least second cART.

Conclusion: Delayed HIV diagnosis and cART initiation resulted in considerable morbidity and poor immune status by adolescent entry. Durable first-line cART regimens to optimize disease control are key to minimizing mortality. Early cART initiation provides the best virologic and immunologic outcomes at transition.

PubMed Disclaimer

Conflict of interest statement

DECLARATION OF CONFLICTING INTERESTS

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1
Figure 1
Proportion of PHIVA on combination antiretroviral therapy across adolescence. cART = combination antiretroviral therapy. PHIVA = perinatally HIV-infected adolescent. Subsequent cART regimen = ≥2nd cART regimen.
See this image and copyright information in PMC

References

    1. Sohn AH, Hazra R. The changing epidemiology of the global paediatric HIV epidemic: keeping track of perinatally HIV-infected adolescents. J Int AIDS Soc. 2013;16:18555. - PMC - PubMed
    1. Hazra R, Siberry GK, Mofenson LM. Growing up with HIV: children, adolescents, and young adults with perinatally acquired HIV infection. Annu Rev Med. 2010;61:169–185. - PubMed
    1. Vreeman RC, Scanlon ML, McHenry MS, Nyandiko WM. The physical and psychological effects of HIV infection and its treatment on perinatally HIV-infected children. J Int AIDS Soc. 2015;18(Suppl 6):20258. - PMC - PubMed
    1. Agwu AL, Fairlie L. Antiretroviral treatment, management challenges and outcomes in perinatally HIV-infected adolescents. J Int AIDS Soc. 2013;16:18579. - PMC - PubMed
    1. Chokephaibulkit K, Kariminia A, Oberdorfer P, et al. Characterizing HIV manifestations and treatment outcomes of perinatally infected adolescents in Asia. Pediatr Infect Dis J. 2014;33(3):291–294. - PMC - PubMed

Publication types

Substances