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Henderson M, Fidler S, Foster C. Adults with Perinatally Acquired HIV; Emerging Clinical Outcomes and Data Gaps. Trop Med Infect Dis 2024; 9:74. [PMID: 38668535 PMCID: PMC11053933 DOI: 10.3390/tropicalmed9040074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 03/29/2024] [Accepted: 03/30/2024] [Indexed: 04/29/2024] Open
Abstract
In resourced settings, adults living with perinatally acquired HIV are approaching the 5th decade of life. Their clinical and psychological outcomes highlight potential future issues for the much larger number of adolescents growing up with HIV in sub-Saharan Africa, and will inform the development of appropriate healthcare services. Lifelong exposure to HIV, and increasingly to antiretroviral therapy throughout growth and development, contrasts with adults acquiring HIV in later life. This review describes the clinical outcomes for adults living with perinatally acquired HIV including post transition mortality, morbidity and retention in care. Rates of viral suppression, drug resistance and immunological function are explored. Co-morbidities focus on metabolic, cardiovascular, respiratory and bone health with quality-of-life data including neurocognitive functioning and mental health. Sexual and reproductive health including vaccine-preventable disease and the prevention of onward transmission to partners and infants are considered. The data gaps and future research questions to optimise outcomes for this emerging adult cohort are highlighted.
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Affiliation(s)
- Merle Henderson
- 900 Clinic, Imperial College Healthcare NHS Trust, London W2 1NY, UK; (M.H.); (S.F.)
- Department of Infectious Diseases, Imperial College London, Imperial College NIHR BRC, London W2 1NY, UK
| | - Sarah Fidler
- 900 Clinic, Imperial College Healthcare NHS Trust, London W2 1NY, UK; (M.H.); (S.F.)
- Department of Infectious Diseases, Imperial College London, Imperial College NIHR BRC, London W2 1NY, UK
| | - Caroline Foster
- 900 Clinic, Imperial College Healthcare NHS Trust, London W2 1NY, UK; (M.H.); (S.F.)
- Department of Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London W2 1NY, UK
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Torres-Fernandez D, Jiménez de Ory S, Fortuny C, Sainz T, Falcón D, Bernal E, Jiménez MC, Vilasaró MN, Epalza C, Navarro M, Ramos JT, Holguín Á, Prieto L. Integrase inhibitors in children and adolescents: clinical use and resistance. J Antimicrob Chemother 2022; 77:2784-2792. [PMID: 35971971 DOI: 10.1093/jac/dkac259] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 07/06/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although integrase inhibitor (INI)-based regimens are now the first-line choice for all people living with HIV, experience among children and adolescents is still scarce. We describe the characteristics and outcomes of a paediatric/adolescent cohort on INI-based ART. METHODS Retrospective analysis of HIV-infected patients below 18 years of age who started an INI-based regimen from 2007 to 2019, enrolled in the Spanish National Adult (CoRIS) and Paediatric (CoRISpe) cohorts. Resistance mutations were identified by the Stanford HIV Drug Resistance Database. RESULTS Overall, 318 INI-based regimens were implemented in 288 patients [53.8% female; median age at start of 14.3 years (IQR 12.0-16.3)]. Most were born in Spain (69.1%), vertically infected (87.7%) and treatment-experienced (92.7%). The most frequently prescribed INI was dolutegravir (134; 42.1%), followed by raltegravir (110; 34.6%) and elvitegravir (73; 23.0%). The median exposure was 2.0 years (IQR 1.1-3.0). The main reasons to start an INI-based therapy were treatment simplification (54.4%) and virological failure (34.3%). In total, 103 (32.4%) patients interrupted their regimen: 14.5% for simplification and 8.5% due to virological failure. Most subjects who received dolutegravir (85.8%) and elvitegravir (83.6%) did not interrupt their regimen and maintained undetectable viral load. There were only five virological failures with dolutegravir and three with elvitegravir. There were no interruptions related to adverse events. Seven patients with virological failure presented major resistance mutations to INIs; none of them were on dolutegravir. CONCLUSIONS INI-based regimens were effective and safe for HIV treatment in children and adolescents. Dolutegravir and elvitegravir presented an excellent profile, and most patients achieved and maintained viral suppression.
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Affiliation(s)
- David Torres-Fernandez
- Paediatric Infectious Diseases Unit, Hospital Universitario 12 de Octubre, Instituto de Investigación imas12, Madrid, Spain.,Universidad Complutense de Madrid (UCM), Madrid, Spain
| | - Santiago Jiménez de Ory
- Instituto de Investigación Sanitaria Gregorio Marañón (IisGM), Hospital Gregorio Marañón, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Claudia Fortuny
- Department of Paediatric Infectious Diseases, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain.,Red de Investigación Traslacional en Infectología Pediátrica (RITIP)
| | - Talía Sainz
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain.,Red de Investigación Traslacional en Infectología Pediátrica (RITIP).,Department of Paediatric Infectious Diseases, Hospital Universitario La Paz and La Paz Hospital Research Institute (IdiPAZ), Madrid, Spain.,Universidad Autonoma de Madrid (UAM), Madrid, Spain
| | - Dolores Falcón
- Red de Investigación Traslacional en Infectología Pediátrica (RITIP).,Department of Paediatric Infectious Diseases, Rheumatology and Immunodeficiency, Hospital Virgen del Rocío, Seville, Spain
| | - Enrique Bernal
- Hospital General Universitario Reina Sofía, Murcia, Spain
| | | | | | - Cristina Epalza
- Paediatric Infectious Diseases Unit, Hospital Universitario 12 de Octubre, Instituto de Investigación imas12, Madrid, Spain.,Universidad Complutense de Madrid (UCM), Madrid, Spain.,Red de Investigación Traslacional en Infectología Pediátrica (RITIP)
| | - Marisa Navarro
- Instituto de Investigación Sanitaria Gregorio Marañón (IisGM), Hospital Gregorio Marañón, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain.,Red de Investigación Traslacional en Infectología Pediátrica (RITIP).,Paediatric Infectious Diseases Unit, Hospital Gregorio Marañón, Madrid, Spain
| | - José Tomás Ramos
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain.,Red de Investigación Traslacional en Infectología Pediátrica (RITIP).,Hospital Clínico San Carlos, Universidad Complutense de Madrid (UCM), Madrid, Spain
| | - África Holguín
- Red de Investigación Traslacional en Infectología Pediátrica (RITIP).,HIV-1 Molecular Epidemiology Laboratory, Microbiology Department, Hospital Universitario Ramón y Cajal-IRYCIS, Madrid, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Luis Prieto
- Paediatric Infectious Diseases Unit, Hospital Universitario 12 de Octubre, Instituto de Investigación imas12, Madrid, Spain.,Universidad Complutense de Madrid (UCM), Madrid, Spain.,Red de Investigación Traslacional en Infectología Pediátrica (RITIP)
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Chappell E, Kohns Vasconcelos M, Goodall RL, Galli L, Goetghebuer T, Noguera‐Julian A, Rodrigues LC, Scherpbier H, Smit C, Bamford A, Crichton S, Navarro ML, Ramos JT, Warszawski J, Spolou V, Chiappini E, Venturini E, Prata F, Kahlert C, Marczynska M, Marques L, Naver L, Thorne C, Gibb DM, Giaquinto C, Judd A, Collins IJ. Children living with HIV in Europe: do migrants have worse treatment outcomes? HIV Med 2022; 23:186-196. [PMID: 34596323 PMCID: PMC9293243 DOI: 10.1111/hiv.13177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 09/10/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To assess the effect of migrant status on treatment outcomes among children living with HIV in Europe. METHODS Children aged < 18 years at the start of antiretroviral therapy (ART) in European paediatric HIV observational cohorts where ≥ 5% of children were migrants (defined as born abroad) were included. Three outcomes were considered: (i) severe immunosuppression-for-age; (ii) viraemic viral load (≥ 400 copies/mL) at 1 year after ART initiation; and (iii) AIDS/death after ART initiation. The effect of migrant status was assessed using univariable and multivariable logistic and Cox models. RESULTS Of 2620 children included across 12 European countries, 56% were migrants. At ART initiation, migrant children were older than domestic-born children (median 6.1 vs. 0.9 years, p < 0.001), with slightly higher proportions being severely immunocompromised (35% vs. 33%) and with active tuberculosis (2% vs. 1%), but a lower proportion with an AIDS diagnosis (14% vs. 19%) (all p < 0.001). At 1 year after beginning ART, a lower proportion of migrant children were viraemic (18% vs. 24%) but there was no difference in multivariable analysis (p = 0.702), and no difference in severe immunosuppression (p = 0.409). However, there was a trend towards higher risk of AIDS/death in migrant children (adjusted hazard ratio = 1.51, 95% confidence interval: 0.96-2.38, p = 0.072). CONCLUSIONS After adjusting for characteristics at ART initiation, migrant children have virological and immunological outcomes at 1 year of ART that are comparable to those who are domestic-born, possibly indicating equity in access to healthcare in Europe. However, there was some evidence of a difference in AIDS-free survival, which warrants further monitoring.
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Affiliation(s)
| | - Malte Kohns Vasconcelos
- Department of Infectious Disease EpidemiologyLondon School of Hygiene and Tropical MedicineLondonUK
- Institute for Medical Microbiology and Hospital HygieneHeinrich Heine University DüsseldorfDüsseldorfGermany
- Paediatric Infectious Diseases Research GroupInstitute for Infection and ImmunitySt. George's, University of LondonLondonUK
| | | | - Luisa Galli
- Infectious Disease UnitDepartment of Health SciencesMeyer Children's HospitalUniversity of FlorenceFlorenceItaly
| | - Tessa Goetghebuer
- Department of PediatricsHôpital St PierreUniversité libre de BruxellesBruxellesBelgium
| | - Antoni Noguera‐Julian
- Infectious Diseases and Systemic Inflammatory Response in Pediatrics, Infectious Diseases UnitDepartment of PediatricsSant Joan de Déu Hospital Research FoundationBarcelonaSpain
- Center for Biomedical Network Research on Epidemiology and Public Health (CIBERESP)MadridSpain
- Department of PediatricsUniversity of BarcelonaBarcelonaSpain
- Translational Research Network in Pediatric Infectious Diseases (RITIP)MadridSpain
| | - Laura C. Rodrigues
- Department of Infectious Disease EpidemiologyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Henriette Scherpbier
- Emma Children's Hospital/Amsterdam University Medical CentreAmsterdamThe Netherlands
| | - Colette Smit
- Stichting HIV MonitoringAmsterdamThe Netherlands
| | - Alasdair Bamford
- MRC Clinical Trials Unit at UCLLondonUK
- Great Ormond Street Hospital for Children NHS TrustLondonUK
- University College London Great Ormond Street Institute of Child HealthLondonUK
| | | | - Marissa Luisa Navarro
- Translational Research Network in Pediatric Infectious Diseases (RITIP)MadridSpain
- Hospital General Universitario "Gregorio Marañón"MadridSpain
- Universidad ComplutenseMadridSpain
- Instituto de Investigación Sanitaria Gregorio Marañón (IISGM)MadridSpain
| | - Jose T. Ramos
- Departamento de Salud Pública y Materno‐infantilUniversidad ComplutenseHospital Clínico San CarlosInstituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC)MadridSpain
| | - Josiane Warszawski
- Service d'Epidémiologie et Santé PubliqueAP‐HPHôpital BicêtreLe Kremlin‐BicêtreFrance
- Unité de Recherche Clinique Paris Descartes Necker CochinAP‐HPParisFrance
| | - Vana Spolou
- First Department of PaediatricsInfectious Diseases Unit, “Agia Sophia” Childrens' HospitalAthensGreece
| | - Elena Chiappini
- Infectious Disease UnitDepartment of Health SciencesMeyer Children's HospitalUniversity of FlorenceFlorenceItaly
| | - Elisabetta Venturini
- Infectious Disease UnitDepartment of Health SciencesMeyer Children's HospitalUniversity of FlorenceFlorenceItaly
| | | | - Christian Kahlert
- Children's Hospital of Eastern Switzerland and Cantonal HospitalInfectious Diseases and Hospital EpidemiologySt GallenSwitzerland
| | | | - Laura Marques
- Centro Hospitalar e Universitário do PortoPortoPortugal
| | - Lars Naver
- Karolinska University Hospital and Karolinska InstitutetStockholmSweden
| | - Claire Thorne
- University College London Great Ormond Street Institute of Child HealthLondonUK
| | | | - Carlo Giaquinto
- Department of Women and Child HealthUniversity of PadovaPadovaItaly
| | - Ali Judd
- MRC Clinical Trials Unit at UCLLondonUK
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