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Multicenter Study
. 2023 Feb;11(2):e778.
doi: 10.1002/iid3.778.

Reduced probability of improving viro-immunological state in subjects with vertical transmission of HIV reaching adult age: A multicenter retrospective cohort study

Francesca Pennati  1 , Stefano Calza  2 , Antonio Di Biagio  3 , Cristina Mussini  4 , Stefano Rusconi  5 , Stefano Bonora  6 , Alberto Borghetti  7 , Eugenia Quiros-Roldan  1 , Giovanni Sarteschi  3 , Marianna Menozzi  4 , Micol Ferrara  6 , Anna Celotti  1 , Arturo Ciccullo  8 , Vania Giacomet  9 , Ilaria Izzo  1 , Laura Dotta  10 , Raffaele Badolato  10 , Francesco Castelli  1 , Emanuele Focà  1
Affiliations
Multicenter Study

Reduced probability of improving viro-immunological state in subjects with vertical transmission of HIV reaching adult age: A multicenter retrospective cohort study

Francesca Pennati et al. Immun Inflamm Dis. 2023 Feb.

Abstract

Introduction: Young adults with vertical transmission (VT) of human immunodeficiency virus (HIV) represent a fragile population. This study evaluates factors associated with viro-immunological outcome of these patients.

Methods: We performed a multicenter study including HIV-infected subjects with VT ≥ 18 years old from six Italian clinics. Subjects were observed from birth to death, lost to follow-up, or last visit until December 31, 2019. Condition of "optimal viro-immunological status" (OS) was defined as the simultaneous presence of HIV ribonucleic acid (RNA) < 50 copies/mL, CD4+ > 500 cells/mm3 , and CD4+/CD8+ ratio ≥ 1.

Results: A total of 126 subjects were enrolled. At 18 years of age, 52/126 (44.4%) had HIV-RNA > 50 copies/mL, 47/126 (38.2%) had CD4+ < 500/mm3 , and 78/126 (67.2%) had CD4+/CD8+ < 1; 28 subjects (23.7%) presented in the condition of OS. Having a CD4+/CD8+ ratio ≥ 1 at 18 years of age was related with an increased probability of shift from suboptimal viro-immunological status (SOS) to OS (HR: 7.7, 95% confidence interval [CI]: 4.23-14.04), and a reduced risk of shift from the OS to the SOS (HR: 0.49, 95% CI: 0.26-0.92). Acquired immunodeficiency syndrome (AIDS) diagnosis significantly reduced the probability of shift from a viro-immunological SOS to OS (HR: 0.09, 95% CI: 0.03-0.30). Subjects who had not achieved an OS at 18 years of age had an increased risk of discontinuation of combination antiretroviral therapy (cART, p = .019).

Conclusions: Only a small proportion of subjects with VT of HIV reached the adult age with "OS". Transition to the adult care with a compromised viro-immunological condition represents a negative driver for future optimal infection control, with a higher risk of discontinuation of cART and a reduced probability to improve the immunological status later in the years.

Keywords: HIV; antiretroviral therapy; discontinuation; vertical transmission; viro-immunological effectiveness.

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Conflict of interest statement

Emanuele Focà received speakers' honoraria, research grants, and advisory board fees from Viiv Healthcare, Janssen‐Cilag, Gilead Sciences, and Merck Sharp & Dohme. The remaining authors declare no conflict of interest.

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