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. 2023 May 4;18(5):e0284395.
doi: 10.1371/journal.pone.0284395. eCollection 2023.

Adoption is not associated with immunological and virological outcomes in children with perinatally acquired HIV infection in the Netherlands

Malon Van Den Hof  1 , Colette Smit  2 , Annemarie M C Van Rossum  3 , Pieter L A Fraaij  3 , Tom F W Wolfs  4 , Sibyl P M Geelen  4 , Henriette J Scherpbier  1 , Elisabeth H Schölvinck  5 , Koen Van Aerde  6 , Peter Reiss  2   7   8 , Ferdinand W N M Wit  2   7   8 , Dasja Pajkrt  1 ; ATHENA cohort study group
Affiliations

Adoption is not associated with immunological and virological outcomes in children with perinatally acquired HIV infection in the Netherlands

Malon Van Den Hof et al. PLoS One. .

Abstract

Objectives: To provide an overview of the demographics, treatment characteristics and long-term outcomes of children with perinatal HIV-1 infection (PHIV) living in the Netherlands (NL) and to specifically investigate whether outcomes differ by children's adoption status.

Design: A prospective population-based open cohort including children with PHIV in NL.

Methods: We included children with PHIV who had entered HIV care in NL since 2007, in view of a sharp increase in the number of adopted children with PHIV since that year. We compared the proportion with virologic suppression and CD4+T-cell count over time between the following groups of children with PHIV: adopted and born outside NL, non-adopted born in NL, and non-adopted born outside NL, using generalized estimating equations and linear mixed effects models, respectively. To account for the variation in cohort inclusion, we analyzed data of children exposed to at least one year of antiretroviral therapy (ART).

Results: We included 148 children (827.5 person-years of follow-up, 72% adopted, age at start care in NL 2.4 (0.5-5.3)). Under-18 mortality was zero. Over the years, a boosted PI-based regimen was most often prescribed. The use of integrase inhibitors increased since 2015. Non-adopted children born in NL were less likely to achieve virological suppression compared to adopted children (OR 0.66, 95%CI 0.51-0.86, p = 0.001), which disappeared after excluding one child with suspected treatment nonadherence (OR 0.85, 95%CI 0.57-1.25, p = 0.400). CD4+T-cell Z-score trajectories were not significantly different between groups.

Conclusions: Despite considerable and increasing diversity of the population of children with PHIV in NL, geographical origin and adoption status do not seem to pose important challenges in achieving good immunological and virological outcomes.

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Conflict of interest statement

MH, CS, AvR, TW, SG, ES, KvA, FW and DP and reported no conflicts of interest. PF receives funding from PREPARE Europe (EU FP7 grant no 602525). HS received a small grant from Gilead. PR through his institution has received independent scientific grant support from Gilead Sciences, Janssen Pharmaceuticals Inc, Merck & Co and ViiV Healthcare, and has served on scientific advisory boards for Gilead Sciences, ViiV Healthcare, Merck & Co, Teva pharmaceutical industries, for which honoraria were all paid to his institution. None related to the current manuscript. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Antiretroviral therapy use and composition in children with perinatally acquired HIV infection (PHIV) in the Netherlands (NL) per calendar year.
Figure shows data of children with PHIV who entered HIV care since 2007. Dual axis chart shows 1) the percentage of children on ART and using a particular regimen (left y-axis) represented by different colored stacked bars, and 2) the median age (right y-axis, solid black line) and interquartile range (dotted black lines) of the cohort of children with PHIV in care in each calendar year. The number of children in care in each calendar year are provided on top of each bar. ‘Mono’ represents NNRTI and PI monotherapy. ‘Other’ represents regimens without a NRTI backbone (1 NRTI + 1 NNRTI + 1 PI), or NRTI-only regimens (dual or triple NRTI therapy). Abbreviations: INSTI, integrase strand transfer inhibitors; NRTI, nucleos(t)ide reverse transcriptase inhibitor; NNRTI, non-nucleoside reverse transcriptase inhibitor; PI, protease inhibitor; EFV, efavirenz; NVP, nevirapine; ATV, atazanavir; DRV, darunavir; LPV, lopinavir; n, number; Q1, first quartile; Q3, third quartile.
Fig 2
Fig 2. Initial antiretroviral therapy started in children with perinatally acquired HIV infection(PHIV) in the Netherlands (NL) per calendar year.
Figure shows the data of PHIV children who entered HIV care in the Netherlands since 2007. Abbreviations: DRV, darunavir; EFV, efavirenz; INSTI, integrase strand transfer inhibitors; LPV, lopinavir; NVP, nevirapine; NNRTI, non-nucleoside reverse transcriptase inhibitor; n, number; PI, protease inhibitor.
Fig 3
Fig 3. Percentage of PHIV children with virological suppression over time.
Figure shows the data of PHIV children who entered HIV care in the Netherlands since 2007 and who have been prescribed at least one year of antiretroviral therapy (ART). Virological suppression was defined as HIV viral load below 200c/mL. Different groups of geographical origin and adoption status are represented by green (adopted and born outside the Netherlands [NL]), red (not adopted and born in NL), and purple (not adopted and born outside NL).
Fig 4
Fig 4. CD4+T-cell Z-score among children with perinatally acquired HIV infection (PHIV) in the Netherlands (NL) over time.
Figure shows the data of PHIV children who entered HIV care since 2007 and who have been prescribed at least one year of antiretroviral therapy (ART). We generated Z-scores out of absolute CD4+T-cell counts using age-related reference values. Different groups of geographical origin and adoption status are represented by green (adopted and born outside the Netherlands [NL]), red (not adopted and born in NL), and purple (not adopted and born outside NL). The shaded areas in the corresponding colors represent the interquartile range.
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