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. 2021 Jul 16:9:665764.
doi: 10.3389/fped.2021.665764. eCollection 2021.

Real-World Analysis of Survival and Clinical Events in a Cohort of Italian Perinatally HIV-1 Infected Children From 2001 to 2018

Elena Chiappini  1   2 , Francesca Larotonda  1   2 , Catiuscia Lisi  1   2 , Vania Giacomet  3 , Paola Erba  3 , Stefania Bernardi  4 , Paola Zangari  5 , Antonio Di Biagio  6 , Lucia Taramasso  6 , Carlo Giaquinto  7 , Osvalda Rampon  7 , Clara Gabiano  8 , Silvia Garazzino  8 , Claudia Tagliabue  9 , Susanna Esposito  10 , Eugenia Bruzzese  11 , Raffaele Badolato  12 , Domenico Zanaboni  13 , Monica Cellini  14 , Maurizio Dedoni  15 , Antonio Mazza  16 , Andrea Pession  17 , Anna Maria Giannini  18 , Filippo Salvini  19 , Icilio Dodi  20 , Ines Carloni  21 , Salvatore Cazzato  21 , Pier Angelo Tovo  8 , Maurizio de Martino  1   2 , Luisa Galli  1   2
Affiliations

Real-World Analysis of Survival and Clinical Events in a Cohort of Italian Perinatally HIV-1 Infected Children From 2001 to 2018

Elena Chiappini et al. Front Pediatr. .

Abstract

Background: Combined antiretroviral therapy (cART) has been associated with a steep decrease in mortality and morbidity in HIV-1 infected children. New antiretroviral molecules and drug classes have been developed and the management of HIV-infected children has improved, but recent data on survival are limited. Methods: An observational retrospective study investigating changes in mortality and morbidity was conducted on 1,091 perinatally HIV-1 infected children enrolled in the Italian Register for HIV Infection in Children and followed-up from 2001 to 2018. Results: Three hundred and fifty-four (32%) AIDS events and 26 (2%) deaths occurred overtime. Mortality rates decreased from 0.4/100 person-years in 2001-2006 to 0.27/100 person-years in 2007-2012 and 0.07/100 person-years in 2013-2018. Notably, 92% of the dead children were born in Italy, but only 50% were followed-up since birth or within three months of age. Seventy three percent of children had started cART at age ≥6 months; 23% were treated for <30 days before death. B and C clinical events progressively decreased (P < 0.0001). Opportunistic infections significantly decreased over time, but still were the most common events in all the periods (6.76/100 person-years in 2013-2018). In the last period, severe bacterial infections were the most common ones. Cancer rates were 0.07/100; 0.17/100; 0.07/100 person-years in the three periods, respectively. Conclusions: Progressive reductions both in mortality and in rates of class B and C clinical events and OIs have been observed during the cART era. However, deaths were still registered; more than half of dead children were enrolled after birth and had belatedly started cART.

Keywords: HIV; aids; antiretroviral therapy (ART); children; epidemiology; perinatal infection; survival.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Children included and excluded from the study population.
Figure 2
Figure 2
Number of children who contributed to the three periods of analysis.
Figure 3
Figure 3
Deaths occurred in HIV-1 infected children by calendar period, from 1985 to 2018 [1985–1995 and 1996–2000 periods refer to our previous results (18)].
Figure 4
Figure 4
CDC clinical events of class B and C occurred in HIV-1 infected children by calendar period, from 1985 to 2018 [1985–1995 and 1996–2000 periods refer to our previous results (18)].
Figure 5
Figure 5
Encephalopathies/neurocognitive delay occurred in HIV-1 infected children by calendar period, from 1985 to 2018 [1985–1995 and 1996–2000 periods refer to our previous results (18)].
See this image and copyright information in PMC

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