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Walle BG, Tiruneh CM, Wubneh M, Chekole B, Kassaw A, Assefa Y, Abebe K, Yigzaw ZA. Treatment failure among Sub-Sahara African children living with HIV: a systematic review and meta-analysis. Ital J Pediatr 2024; 50:202. [PMID: 39354602 PMCID: PMC11446064 DOI: 10.1186/s13052-024-01706-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 07/16/2024] [Indexed: 10/03/2024] Open
Abstract
BACKGROUND Antiretroviral treatment failure is a global issue, particularly in developing countries such as Sub-Saharan Africa. Prior research findings were highly variable and inconsistent across areas. As a result, the goal of this systematic review and meta-analysis was to determine the pooled prevalence of treatment failure among children receiving antiretroviral medication in Sub-Saharan Africa. METHODS To find qualifying papers, we searched databases (such as PubMed, Google Scholar, African Journals Online, Scopus, and the Cochrane Library). The data were retrieved using Microsoft Excel and exported to STATA Version 14 for analysis. To check for publication bias, we employed Egger and Begg's regression tests. A random-effects model was used to assess the pooled prevalence of treatment failure due to high levels of variability. RESULTS Following the removal of duplicated articles and quality screening, a total of 33 primary articles were determined to be appropriate for inclusion in the final analysis for this study. Overall, the pooled prevalence of treatment failure among HIV-infected children was 25.86% (95% CI: 21.46, 30.26). There is great variety across the included studies, with the majority of them being conducted in Ethiopia. Cameroon had the greatest pooled prevalence of treatment failure among HIV-infected children, at 39.41% (95% CI: 21.54, 57.28), while Ethiopia had the lowest, at 13.77% (95% CI: 10.08, 17.47). CONCLUSIONS The pooled estimate prevalence of treatment failure among HIV-infected children in Sub-Saharan Africa was high. The implementation of national and international policies and strategies on ART clinic care services should be given special focus in order to reduce treatment failure in children living with HIV/AIDS. TRIAL REGISTRATION The protocol has been registered in the PROSPERO database under the registration number CRD-429011.
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Affiliation(s)
- Belete Gelaw Walle
- Department of Pediatric and Child Health Nursing, School of Nursing, College of Health Science and Medicine, Wolaita Sodo University, Wolaita, Sodo, Ethiopia.
| | - Chalie Marew Tiruneh
- Department of Pediatric and Child Health Nursing, College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Moges Wubneh
- Department of Adult health Nursing, College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Bogale Chekole
- Department of Pediatric and Child Health Nursing, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Amare Kassaw
- Department of Pediatric and Child Health Nursing, College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Yibeltal Assefa
- School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Kelemu Abebe
- School of Midwifery, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Zeamanuel Anteneh Yigzaw
- Department of health promotion, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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2
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Seng R, Frange P, Faye A, Dollfus C, le Chenadec J, Boufassa F, Essat A, Goetghebuer T, Arezes E, Avettand-Fènoël V, Bigna JJ, Blanche S, Goujard C, Meyer L, Warszawski J, Viard JP. Immunovirological status in people with perinatal and adult-acquired HIV-1 infection: a multi-cohort analysis from France. THE LANCET REGIONAL HEALTH. EUROPE 2024; 40:100885. [PMID: 38576825 PMCID: PMC10993179 DOI: 10.1016/j.lanepe.2024.100885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 02/16/2024] [Accepted: 02/26/2024] [Indexed: 04/06/2024]
Abstract
Background No study has compared the virological and immunological status of young people with perinatally-acquired HIV infection (P-HIV) with that of people with HIV adulthood (A-HIV) having a similar duration of infection. Methods 5 French cohorts of P-HIV and A-HIV patients with a known date of HIV-infection and receiving antiretroviral treatment (ART), were used to compare the following proportions of: virological failure (VF) defined as plasma HIV RNA ≥ 50 copies/mL, CD4 cell percentages and CD4:CD8 ratios, at the time of the most recent visit since 2012. The analysis was stratified on time since infection, and multivariate models were adjusted for demographics and treatment history. Findings 310 P-HIV were compared to 1515 A-HIV (median current ages 20.9 [IQR:14.4-25.5] and 45.9 [IQR:37.9-53.5] respectively). VF at the time of the most recent evaluation was significantly higher among P-HIV (22.6%, 69/306) than A-HIV (3.3%, 50/1514); p ≤ 0.0001. The risk of VF was particularly high among the youngest children (2-5 years), adolescents (13-17 years) and young adults (18-24 years), compared to A-HIV with a similar duration of infection: adjusted Odds-Ratio (aOR) 7.0 [95% CI: 1.7; 30.0], 11.4 [4.2; 31.2] and 3.3 [1.0; 10.8] respectively. The level of CD4 cell percentages did not differ between P-HIV and A-HIV. P-HIV aged 6-12 and 13-17 were more likely than A-HIV to have a CD4:CD8 ratio ≥ 1: 84.1% vs. 58.8% (aOR = 3.5 [1.5; 8.3]), and 60.9% vs. 54.7% (aOR = 1.9 [0.9; 4.2]) respectively. Interpretation P-HIV were at a higher risk of VF than A-HIV with a similar duration of infection, even after adjusting for treatment history, whereas they were not at a higher risk of immunological impairment. Exposure to viral replication among young patients living with HIV since birth or a very early age, probably because of lower adherence, could have an impact on health, raising major concerns about the selection of resistance mutations and the risk of HIV transmission. Funding Inserm - ANRS MIE.
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Affiliation(s)
- Rémonie Seng
- INSERM CESP U1018, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Epidemiology and Public Health Department, Hôpitaux Universitaires Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Pierre Frange
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Clinical Microbiology, Necker-Enfants Malades Hospital, Paris, France
- URP 7328 FETUS, Université Paris Cité, Paris, France
| | - Albert Faye
- Assistance Publique-Hôpitaux de Paris (AP-HP), General Pediatrics and Infectious Diseases, Robert Debré Hospital, Paris, France
- Université Paris Cité, Paris, France
| | - Catherine Dollfus
- Assistance Publique-Hôpitaux de Paris (AP-HP), Pediatric Hematology and Oncology Department, Trousseau Hospital, Paris, France
| | | | - Faroudy Boufassa
- INSERM CESP U1018, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Asma Essat
- INSERM CESP U1018, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Tessa Goetghebuer
- Pediatric Department, Saint-Pierre Hospital, Brussels, Belgium
- Université Libre de Bruxelles, Belgium
| | - Elisa Arezes
- INSERM CESP U1018, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Véronique Avettand-Fènoël
- Université d’Orléans, CHU Orléans, Laboratoire de Virologie, Orléans, France
- Université Paris Cité, INSERM U1016, CNRS UMR8104, Institut Cochin, Paris, France
| | - Jean-Joël Bigna
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Stéphane Blanche
- Assistance Publique-Hôpitaux de Paris (AP-HP), Paediatric Immunology and Hematology Unit, Necker Enfants Malades Hospital, Paris, France
| | - Cécile Goujard
- INSERM CESP U1018, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Internal Medicine and Clinical Immunology Department, Hôpitaux Universitaires Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Laurence Meyer
- INSERM CESP U1018, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Epidemiology and Public Health Department, Hôpitaux Universitaires Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Josiane Warszawski
- INSERM CESP U1018, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Epidemiology and Public Health Department, Hôpitaux Universitaires Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Jean-Paul Viard
- Assistance Publique-Hôpitaux de Paris (AP-HP), Immunology-Infectious Diseases Unit, Hôtel-Dieu Hospital, Université Paris Cité, Paris, France
| | - COVERTE
- INSERM CESP U1018, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Epidemiology and Public Health Department, Hôpitaux Universitaires Paris-Saclay, Le Kremlin-Bicêtre, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Clinical Microbiology, Necker-Enfants Malades Hospital, Paris, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), General Pediatrics and Infectious Diseases, Robert Debré Hospital, Paris, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Pediatric Hematology and Oncology Department, Trousseau Hospital, Paris, France
- Pediatric Department, Saint-Pierre Hospital, Brussels, Belgium
- Université d’Orléans, CHU Orléans, Laboratoire de Virologie, Orléans, France
- Université Paris Cité, INSERM U1016, CNRS UMR8104, Institut Cochin, Paris, France
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
- Assistance Publique-Hôpitaux de Paris (AP-HP), Paediatric Immunology and Hematology Unit, Necker Enfants Malades Hospital, Paris, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Internal Medicine and Clinical Immunology Department, Hôpitaux Universitaires Paris-Saclay, Le Kremlin-Bicêtre, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Immunology-Infectious Diseases Unit, Hôtel-Dieu Hospital, Université Paris Cité, Paris, France
- Université Paris Cité, Paris, France
- Université Libre de Bruxelles, Belgium
- URP 7328 FETUS, Université Paris Cité, Paris, France
| | - PRIMO
- INSERM CESP U1018, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Epidemiology and Public Health Department, Hôpitaux Universitaires Paris-Saclay, Le Kremlin-Bicêtre, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Clinical Microbiology, Necker-Enfants Malades Hospital, Paris, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), General Pediatrics and Infectious Diseases, Robert Debré Hospital, Paris, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Pediatric Hematology and Oncology Department, Trousseau Hospital, Paris, France
- Pediatric Department, Saint-Pierre Hospital, Brussels, Belgium
- Université d’Orléans, CHU Orléans, Laboratoire de Virologie, Orléans, France
- Université Paris Cité, INSERM U1016, CNRS UMR8104, Institut Cochin, Paris, France
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
- Assistance Publique-Hôpitaux de Paris (AP-HP), Paediatric Immunology and Hematology Unit, Necker Enfants Malades Hospital, Paris, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Internal Medicine and Clinical Immunology Department, Hôpitaux Universitaires Paris-Saclay, Le Kremlin-Bicêtre, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Immunology-Infectious Diseases Unit, Hôtel-Dieu Hospital, Université Paris Cité, Paris, France
- Université Paris Cité, Paris, France
- Université Libre de Bruxelles, Belgium
- URP 7328 FETUS, Université Paris Cité, Paris, France
| | - SEROPRI
- INSERM CESP U1018, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Epidemiology and Public Health Department, Hôpitaux Universitaires Paris-Saclay, Le Kremlin-Bicêtre, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Clinical Microbiology, Necker-Enfants Malades Hospital, Paris, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), General Pediatrics and Infectious Diseases, Robert Debré Hospital, Paris, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Pediatric Hematology and Oncology Department, Trousseau Hospital, Paris, France
- Pediatric Department, Saint-Pierre Hospital, Brussels, Belgium
- Université d’Orléans, CHU Orléans, Laboratoire de Virologie, Orléans, France
- Université Paris Cité, INSERM U1016, CNRS UMR8104, Institut Cochin, Paris, France
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
- Assistance Publique-Hôpitaux de Paris (AP-HP), Paediatric Immunology and Hematology Unit, Necker Enfants Malades Hospital, Paris, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Internal Medicine and Clinical Immunology Department, Hôpitaux Universitaires Paris-Saclay, Le Kremlin-Bicêtre, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Immunology-Infectious Diseases Unit, Hôtel-Dieu Hospital, Université Paris Cité, Paris, France
- Université Paris Cité, Paris, France
- Université Libre de Bruxelles, Belgium
- URP 7328 FETUS, Université Paris Cité, Paris, France
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3
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Moretti M, Stoffels K, Van Laethem K, Verhofstede C, Van Den Wijngaert S, Martin C. The Challenge of Adherence to a Complex Antiretroviral Therapy Regimen in an Individual With Multidrug-Resistant HIV. TOPICS IN ANTIVIRAL MEDICINE 2024; 32:437-444. [PMID: 39141922 PMCID: PMC11293606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
Limited therapeutic options are available for patients with multidrug-resistant HIV. This report describes a 38-year-old female who was perinatally infected with HIV-1 and treated with 14 different antiretroviral regimens over 27 years, gradually leading to 4-class drug resistance. Despite various attempts to obtain sustained viral suppression, including the off-label administration of intravenous foscarnet and enfuvirtide, and thorough follow-up with 16 viral genotyping/phenotyping from 1999 to 2021, viral control was not maintained. Recently, the introduction of a regimen with fostemsavir and lenacapavir resulted in long-term viral suppression.
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4
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Heidary M, Shariati S, Nourigheimasi S, Khorami M, Moradi M, Motahar M, Bahrami P, Akrami S, Kaviar VH. Mechanism of action, resistance, interaction, pharmacokinetics, pharmacodynamics, and safety of fostemsavir. BMC Infect Dis 2024; 24:250. [PMID: 38395761 PMCID: PMC10885622 DOI: 10.1186/s12879-024-09122-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 02/09/2024] [Indexed: 02/25/2024] Open
Abstract
The Food and Drug Administration (FDA) has licensed many antiretroviral medications to treat human immunodeficiency virus type 1 (HIV-1), however, treatment options for people with multi-drug resistant HIV remain limited. Medication resistance, undesirable effects, prior tolerance, and previous interlacement incapacity to deliver new drug classes all lead to the requirement for new medication classes and drug combination therapy. Fostemsavir (FTR) is a new CD-4 attachment inhibitor medicine that was recently authorized by the United States FDA to treat HIV-1. In individuals with multidrug-resistant (MDR) HIV-1, FTR is well tolerated and virologically active. According to recent investigations, drug combination therapy can positively affect MDR-HIV. The mechanism of action, resistance, interaction, pharmacokinetics, pharmacodynamics, and safety of FTR has been highlighted in this review.
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Affiliation(s)
- Mohsen Heidary
- Department of Laboratory Sciences, School of Paramedical Sciences, Sabzevar University of Medical Sciences, Sabzevar, Iran
- Cellular and Molecular Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Saeedeh Shariati
- Toxicology Research Center, Medical Basic Sciences Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Mona Khorami
- Department of Obstetrics and Gynecology, School of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Melika Moradi
- Department of Microbiology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Moloudsadat Motahar
- Department of Microbiology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Parisa Bahrami
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Sousan Akrami
- Department of Microbiology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
- Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran.
- Department of Microbiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - Vahab Hassan Kaviar
- Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran.
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5
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Armenia D, Gagliardini R, Alteri C, Svicher V, Cento V, Borghi V, Vergori A, Cicalini S, Forbici F, Fabeni L, Bertoli A, Brugneti M, Gennari W, Malagnino V, Andreoni M, Mussini C, Antinori A, Perno CF, Santoro MM, Ceccherini-Silberstein F. Temporal trend of drug-resistance and APOBEC editing in PBMC genotypic resistance tests from HIV-1 infected virologically suppressed individuals. J Clin Virol 2023; 168:105551. [PMID: 37573167 DOI: 10.1016/j.jcv.2023.105551] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND We aimed at evaluating the temporal trend of drug-resistance and APOBEC editing from HIV-DNA genotypic resistance tests (GRT) in virologically suppressed individuals. MATERIAL AND METHODS Major resistance mutations (MRM), genotypic susceptibility score (GSS) for the current regimen and APOBEC-related mutations (APO-M) were evaluated. Potential changes in trends of MRM and APO-M over-time were assessed and predictors of MRM detection or sub-optimal GSS (GSS<2) at HIV-DNA-GRT were estimated through logistic regression analyses. RESULTS Among the 1126 individuals included, 396 (35.2%) harboured at least one MRM (23.4% to NRTI, 18.8% to NNRTI, 7.7% to PI and 1.4% to INSTI [N=724]); 132 (12.3%) individuals showed a GSS <2. APO-M and stop codons were found in 229 (20.3%) and 105 (9.3%) individuals, respectively. APO-DRMs were found in 16.8% of individuals and were more likely observed in those individuals with stop codons (40.0%) compared to those without (14.4%, P<0.001). From 2010 to 2021 no significant changes of resistance or APO-M were found. Positive predictors of MRM detection at HIV-DNA GRT were drug abuse, subtype B infection, and a prolonged and complex treatment history. Perinatal infection and having at least 2 stop codons were associated with a current suboptimal regimen. CONCLUSIONS In virologically suppressed individuals, resistance in HIV-DNA and the extent of APOBEC editing were generally stable in the last decade. A careful evaluation of APOBEC editing might be helpful to improve the reliability of HIV-DNA GRT. Further investigations are required to understand how to apply the estimation of APOBEC editing in refining genotypic evaluation.
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Affiliation(s)
- D Armenia
- UniCamillus, Saint Camillus International University of Health Sciences, Rome, Italy
| | - R Gagliardini
- National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - C Alteri
- University of Milan, Milan, Italy
| | - V Svicher
- Department of Experimental Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy
| | - V Cento
- Humanitas Research Hospital, IRCCS, Milan, Italy
| | - V Borghi
- University of Modena and Reggio Emilia, Modena, Italy
| | - A Vergori
- National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - S Cicalini
- National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - F Forbici
- National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - L Fabeni
- National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - A Bertoli
- Department of Experimental Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy; Polyclinic of Rome "Tor Vergata", Rome, Italy
| | - M Brugneti
- Polyclinic of Rome "Tor Vergata", Rome, Italy
| | - W Gennari
- University of Modena and Reggio Emilia, Modena, Italy
| | - V Malagnino
- Polyclinic of Rome "Tor Vergata", Rome, Italy
| | - M Andreoni
- Polyclinic of Rome "Tor Vergata", Rome, Italy
| | - C Mussini
- University of Modena and Reggio Emilia, Modena, Italy
| | - A Antinori
- National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - C F Perno
- Bambino Gesù Children's Hospital, Rome, Italy
| | - M M Santoro
- Department of Experimental Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy.
| | - F Ceccherini-Silberstein
- Department of Experimental Medicine, University of Rome "Tor Vergata", Via Montpellier 1, 00133, Rome, Italy
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Feldman MB, Montero N, Thomas JA, Hoffman S, Nguyen N, Lentz CL, Sukumaran S, Mellins CA. Durable Viral Suppression Among Young Adults Living with HIV Receiving Ryan White Services in New York City. AIDS Behav 2023; 27:3197-3205. [PMID: 37084103 DOI: 10.1007/s10461-023-04040-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 04/22/2023]
Abstract
Identifying factors associated with durable viral suppression (DVS) can inform interventions to support young adults living with HIV (YALWH) in sustaining optimal health. We examined associations between client characteristics and DVS among YALWH aged 18-29 who completed an intake assessment and received ≥ 1 Ryan White Part A service in New York City from 1/2017 to 12/2019. Individuals were classified as achieving DVS at least once if they had ≥ 2 suppressed viral load test results ≥ 90 days apart with: (a) no intervening unsuppressed viral load test results in a 12-month period; and (b) no unsuppressed viral load test results after achieving DVS in that 12-month period. Of 2208 YALWH, 92.1% (n = 2034) had sufficient data in the New York City HIV Surveillance Registry to ascertain DVS status. Of these, 68% achieved DVS at least once. Controlling for ART prescription status at intake, YALWH with higher incomes were significantly more likely to achieve DVS at least once. YALWH with lifetime and recent histories of incarceration and/or drug use were significantly less likely to achieve DVS. Our findings underscore the potential role of tailored harm reduction and post-incarceration programs in reducing health inequities among YALWH.
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Affiliation(s)
- Matthew B Feldman
- New York City Department of Health and Mental Hygiene, Bureau of Hepatitis, HIV, and Sexually Transmitted Infections, Queens, NY, USA.
- JEVS Human Services, 1845 Walnut Street, Philadelphia, PA, 19103, USA.
| | - Noelisa Montero
- New York City Department of Health and Mental Hygiene, Bureau of Hepatitis, HIV, and Sexually Transmitted Infections, Queens, NY, USA
| | - Jacinthe A Thomas
- New York City Department of Health and Mental Hygiene, Bureau of Hepatitis, HIV, and Sexually Transmitted Infections, Queens, NY, USA
| | - Susie Hoffman
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, Department of Psychiatry, New York State Psychiatric Institute and Columbia University, New York, NY, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Nadia Nguyen
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, Department of Psychiatry, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Cody L Lentz
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, Department of Psychiatry, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Stephen Sukumaran
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, Department of Psychiatry, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Claude A Mellins
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, Department of Psychiatry, New York State Psychiatric Institute and Columbia University, New York, NY, USA
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
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7
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Singtoroj T, Teeraananchai S, Chokephaibulkit K, Phanuphak N, Gatechompol S, Hansudewechakul R, Dang HLD, Tran DNH, Kerr S, Sohn AH. Factors Associated with Morbidity and Mortality Among Sexually Active Asian Adolescents and Young Adults with Perinatally Acquired HIV. AIDS Res Hum Retroviruses 2023; 39:285-293. [PMID: 36515173 PMCID: PMC10278009 DOI: 10.1089/aid.2021.0169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
We assessed morbidity and mortality among Thai and Vietnamese adolescents and young adults with perinatally acquired human immunodeficiency virus (PHIV) compared with matched HIV-negative peers, 12-24 years of age. Data on serious adverse events (SAEs) were prospectively collected between 2013 and 2018 according to U.S. NIH Division of AIDS criteria. Of 288 youth, 142 had PHIV and 146 were HIV negative. At enrollment, the overall median age was 19 (interquartile range [IQR] 17-20) years, 67% were female, and 95% were Thai. Almost all PHIV youth (99%) were receiving antiretroviral therapy; 50% self-reported adherence ≥95%. Median CD4 was 579 (IQR 404-800) cells/mm3, and 24% had HIV-RNA ≥1,000 copies/mL. During follow-up, 31 (22%) PHIV youth and 9 (6%) HIV-negative youth had at least one SAE. The overall crude SAE rate was 4.66 (3.42-6.35) per 100 person-years (PY); 7.22 (5.08-10.26) per 100 PY among youth with PHIV and 2.10 (1.09-4.03) per 100 PY in HIV-negative youth (p < .001). All seven deaths that occurred were among those with PHIV and primarily due to opportunistic infections (e.g., pneumocystis pneumonia, tuberculous meningitis). In multivariate analyses, having PHIV, being <20 years of age, and having anogenital high-risk human papillomavirus (HPV) infection with types 16 and/or 18 increased risk of SAEs. Among PHIV youth, CD4 count <350 cells/mm3, HIV-RNA ≥1,000 copies/mL, advanced WHO stages, and having anogenital HPV 16 and/or 18 infection predicted higher incidence of SAEs; no prior use of alcohol was protective. These data emphasize the need for tailored interventions for adolescents with PHIV to prevent long-term morbidity and mortality.
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Affiliation(s)
- Thida Singtoroj
- TREAT Asia/amfAR–The Foundation for AIDS Research, Bangkok, Thailand
| | - Sirinya Teeraananchai
- HIV-NAT, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand
- Department of Statistics, Faculty of Science, Kasetsart University, Bangkok, Thailand
| | - Kulkanya Chokephaibulkit
- Siriraj Institute of Clinical Research, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Sivaporn Gatechompol
- HIV-NAT, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand
- Tuberculosis Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | | | | | - Stephen Kerr
- HIV-NAT, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand
- Biostatistics Excellence Centre, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Annette H. Sohn
- TREAT Asia/amfAR–The Foundation for AIDS Research, Bangkok, Thailand
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8
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Mode of HIV acquisition among adolescents living with HIV in resource-limited settings: A data-driven approach from South Africa. PLoS One 2023; 18:e0281298. [PMID: 36827268 PMCID: PMC9955664 DOI: 10.1371/journal.pone.0281298] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 01/19/2023] [Indexed: 02/25/2023] Open
Abstract
Adolescents living with HIV (ALHIV) face unique treatment and care challenges which may differ by how they acquired HIV, whether vertically (in-utero, perinatal or postnatal exposure during breastfeeding) or sexually (sexual exposure). Distinguishing and documenting the mode of HIV acquisition (MOHA) is crucial to further research on the different needs and outcomes for ALHIV and to tailor HIV services to their needs. Age-based cut-offs have been used to attribute MOHA but have not been validated. We analysed data from a three-wave cohort of n = 1107 ALHIV part of a longitudinal study in South Africa. Age-based MOHA was allocated using age at ART initiation, validated against a logic-tree model based on literature-hypothesised factors: self-reported HIV, sexual, and family history. After testing six ART initiation age cut-offs (10 to 15 years old), we determined the optimal MOHA cut-off age by calculating the sensitivity and specificity for each cut-off, measured against the final logic-tree allocation. Following validation using this longitudinal study, the methodology is extended to 214 additional third-wave participants-adolescent girls and young women living with HIV who became mothers before the age of 20. Finally, descriptive statistics of the final allocations are presented. Among the 1,063 (96.0%) cohort study participants classified, 68.7% acquired HIV vertically, following validation. ART initiation before cut-off age 10 had the highest sensitivity (58.9%) but cut-off age 12 had the largest area under the curve (AUC) (0.712). Among the additional young mothers living with HIV, 95.3% were estimated to have acquired it sexually, following the same algorithm. For this group, while cut-off ages 10 to 12 had the highest sensitivity (92.2%), age 14 had the highest AUC (0.703). ART initiation before 10 years old is strongly associated with vertical HIV acquisition. Therefore, a cut-off age of 10 would remain the recommendation in LMIC regions with similar epidemiology as South Africa for determining MOHA in research and clinic settings.
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9
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Temereanca A, Ruta S. Strategies to overcome HIV drug resistance-current and future perspectives. Front Microbiol 2023; 14:1133407. [PMID: 36876064 PMCID: PMC9978142 DOI: 10.3389/fmicb.2023.1133407] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 01/30/2023] [Indexed: 02/18/2023] Open
Abstract
The availability of combined antiretroviral therapy (cART) has revolutionized the course of HIV infection, suppressing HIV viremia, restoring the immune system, and improving the quality of life of HIV infected patients. However, the emergence of drug resistant and multidrug resistant strains remains an important contributor to cART failure, associated with a higher risk of HIV-disease progression and mortality. According to the latest WHO HIV Drug Resistance Report, the prevalence of acquired and transmitted HIV drug resistance in ART naive individuals has exponentially increased in the recent years, being an important obstacle in ending HIV-1 epidemic as a public health threat by 2030. The prevalence of three and four-class resistance is estimated to range from 5 to 10% in Europe and less than 3% in North America. The new drug development strategies are focused on improved safety and resistance profile within the existing antiretroviral classes, discovery of drugs with novel mechanisms of action (e.g., attachment/post-attachment inhibitors, capsid inhibitors, maturation inhibitors, nucleoside reverse transcriptase translocation inhibitors), combination therapies with improved adherence, and treatment simplification with infrequent dosing. This review highlight the current progress in the management of salvage therapy for patients with multidrug-resistant HIV-1 infection, discussing the recently approved and under development antiretroviral agents, as well as the new drug targets that are providing a new avenue for the development of therapeutic interventions in HIV infection.
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Affiliation(s)
- Aura Temereanca
- Virology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Viral Emerging Diseases Department, Stefan S. Nicolau Institute of Virology, Bucharest, Romania
| | - Simona Ruta
- Virology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Viral Emerging Diseases Department, Stefan S. Nicolau Institute of Virology, Bucharest, Romania
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10
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Lyons A, Thompson L, Chappell E, Ene L, Galli L, Goetghebuer T, Jourdain G, Noguera-Julian A, Kahlert CR, Königs C, Kosalaraksa P, Lumbiganon P, Marczyńska M, Marques L, Navarro M, Naver L, Okhonskaia L, Prata F, Puthanakit T, Ramos JT, Samarina A, Thorne C, Voronin E, Turkova A, Giaquinto C, Judd A, Collins IJ. Outcomes of etravirine-based antiretroviral treatment in treatment-experienced children and adolescents living with HIV in Europe and Thailand. Antivir Ther 2022; 27:13596535221092182. [PMID: 36029009 DOI: 10.1177/13596535221092182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Etravirine (ETR) is approved as a component of second or third-line antiretroviral treatment (ART) for children living with HIV. We assessed the outcomes of ETR-based ART in children in routine care in Europe and Thailand. METHODS Data on children aged <18 years at ETR start were pooled from 17 observational cohorts. Characteristics at ETR start, immunological and virological outcomes at 12 months, discontinuations, adverse events (AEs) and serious adverse events (SAEs) were described. Follow-up was censored at ETR discontinuation, death or last visit. RESULTS 177 children ever received ETR. At ETR start, median [IQR] age was 15 [12,16] years, CD4 count 480 [287, 713] cells/mm3, 70% had exposure to ≥3 ART classes and 20% had viral load (VL) <50 copies/mL. 95% received ETR in combination with ≥1 potent drug class, mostly protease inhibitor-based regimens. Median time on ETR was 24 [7, 48] months. Amongst those on ETR at 12 months (n=141), 69% had VL<50 copies/mL. Median CD4 increase since ETR start (n=83) was 147 [16, 267] cells/mm3. Overall, 81 (46%) discontinued ETR by last follow-up. Median time to discontinuation was 23 [8, 47] months. Common reasons for discontinuation were treatment simplification (19%), treatment failure (16%) and toxicity (12%). Eight children (5%) had AEs causally associated with ETR, all dermatological/hypersensitivity reactions. Two were SAEs, both Stevens-Johnson Syndrome in children on regimens containing ETR and darunavir and were causally related to either drugs; both resolved following ART discontinuation. CONCLUSION Children receiving ETR were predominantly highly treatment-experienced, over two-thirds were virally suppressed at 12 months.
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Affiliation(s)
- Alex Lyons
- MRC Clinical Trials Unit at UCL, 4919University College London, London, UK
| | - Lindsay Thompson
- MRC Clinical Trials Unit at UCL, 4919University College London, London, UK
| | - Elizabeth Chappell
- MRC Clinical Trials Unit at UCL, 4919University College London, London, UK
| | - Luminita Ene
- Clinical Department of Infectious Diseases (HIV Department), Dr. Victor Babeș Hospital for Infectious and Tropical Diseases, Bucharest, Romania
| | - Luisa Galli
- Infectious Disease Unit, Meyer Children's Hospital, Department of Health Sciences, University of Florence, Florence, Italy
| | | | - Gonzague Jourdain
- Institut de recherche pour le développement (IRD)-PHPT, Marseille, France
- Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Antoni Noguera-Julian
- Infectious Diseases and Systemic Inflammatory Response in Pediatrics, Infectious Diseases Unit, Department of Pediatrics, Sant Joan de Déu Hospital Research Foundation, Barcelona, Spain
| | - Christian R Kahlert
- Infectious Diseases and Hospital Epidemiology, Children's Hospital of Eastern Switzerland and Cantonal Hospital, St Gallen, Switzerland
| | - Christoph Königs
- Department for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, University Hospital Frankfurt/Main, Frankfurt, Germany
| | - Pope Kosalaraksa
- Department of Pediatrics, Khon Kaen University, Khon Kaen, Thailand
| | | | - Magdalena Marczyńska
- Hospital of Infectious Diseases, 37803Medical University of Warsaw, Warsaw, Poland
| | - Laura Marques
- Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Marissa Navarro
- Hospital General Universitario "Gregorio Marañón", Madrid, Spain
- 16734Universidad Complutense, Madrid, Spain
- 559924Instituto de Investigación Sanitaria Gregorio Marañón (IISGM), Madrid, Spain
- Red de Investigación Translacional en Infectología Pediátrica, RITIP, Madrid, Spain
| | - Lars Naver
- Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Liubov Okhonskaia
- Federal Budgetary Institution "Republican Clinical Infectious Hospital" of the Ministry of Health of the Russian Federation, Saint-Petersburg, Russian Federation
| | | | - Thanyawee Puthanakit
- Department of Pediatrics, Faculty of Medicine, 26683Chulalongkorn University and HIVNAT, Thai Red Cross AIDS Research Center, Bangkok, Thailand
| | - Jose T Ramos
- Departamento de Salud Pública y Materno-infantil, Universidad Complutense, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Anna Samarina
- The City HIV Centre, St Petersburg City AIDS Center, St Petersburg, Russian Federation
| | - Claire Thorne
- University College London Great Ormond Street Institute of Child Health, London, UK
| | - Evgeny Voronin
- Federal Budgetary Institution "Republican Clinical Infectious Hospital" of the Ministry of Health of the Russian Federation, Saint-Petersburg, Russian Federation
| | - Anna Turkova
- MRC Clinical Trials Unit at UCL, 4919University College London, London, UK
- 4956Great Ormond Street Hospital, London, UK
| | - Carlo Giaquinto
- 561043Paediatric European Network for the Treatment of AIDS (Penta), Padova, Italy
| | - Ali Judd
- MRC Clinical Trials Unit at UCL, 4919University College London, London, UK
| | - Intira J Collins
- MRC Clinical Trials Unit at UCL, 4919University College London, London, UK
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11
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Kouamou V, Inzaule S, Manasa J. Weight gain stopping/switch rules for antiretroviral clinical trials. AIDS 2022; 36:1053-1054. [PMID: 35652678 DOI: 10.1097/qad.0000000000003221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - Seth Inzaule
- Amsterdam Institute for Global Health and Development, UMC, University of Amsterdam, Amsterdam, The Netherlands
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12
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Gelaw B, Dessalegn L, Alem E, Tekalign T, Lankirew T, Eshetu K, Marew C, Chekole B, Kassaw A. Prevalence and associated factors of treatment failure among children on ART in Ethiopia: A systematic review and meta-analysis. PLoS One 2022; 17:e0261611. [PMID: 35421084 PMCID: PMC9009617 DOI: 10.1371/journal.pone.0261611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/06/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND As the use of antiretroviral therapy (ART) increases, the issue of treatment failure is still a global challenge, particularly in a resource limited settings including Ethiopia. The results of former studies in Ethiopia were highly variable and inconsistent across studies. Thus, this systematic review and meta-analysis intended to provide the pooled estimation of treatment failure and associated factors among children on antiretroviral therapy. METHODS We searched international databases (i.e., PubMed, Google Scholar, Web of Science, Ethiopian Universities' online repository library, Scopus, and the Cochrane Library) during the period of February 30 to April 7, 2021. All identified observational studies reporting the proportion of treatment failure among HIV positive children in Ethiopia were included. Heterogeneity of the studies was checked using I2 test and Cochrane Q test statistics. We run Begg's regression test to assess publication bias. A random-effects meta-analysis model was performed to estimate the pooled prevalence of treatment failure. RESULTS The estimated pooled prevalence of treatment failure among children in Ethiopia was 12.34 (95%CI: 8.59, 16.10). Subgroup analysis of this review showed that the highest prevalence was observed in Addis Ababa (15.92%), followed by Oromia region (14.47%). Poor ART adherence (AOR = 2.53, CI: 2.03, 4.97), advanced WHO clinical staging (AOR = 1.66, CI: 1.24, 3.21), and opportunistic infections (AOR = 2.64 CI: 2.19, 4.31 were found to be significantly associated factors with childhood treatment failure. CONCLUSIONS This study revealed that treatment failure among children on ART was high in Ethiopia. Poor ART adherence, advanced WHO clinical staging, opportunistic infections, and low level of CD4 cell counts increased the risk of treatment failure.
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Affiliation(s)
- Belete Gelaw
- Department of Pediatric and Child Health Nursing, School of Nursing, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Lemma Dessalegn
- Department of Pediatric and Child Health Nursing, School of Nursing, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Eyasu Alem
- Department of Pediatric and Child Health Nursing, School of Nursing, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Tiwabwork Tekalign
- Department of Nursing, School of Nursing, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Tadele Lankirew
- Department of Nursing, School of Nursing, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Kirubel Eshetu
- Department of Nursing, School of Nursing, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Chalie Marew
- Department of Pediatric and Child Health Nursing, College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Bogale Chekole
- Department of Pediatric and Child Health Nursing, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Amare Kassaw
- Department of Pediatric and Child Health Nursing, College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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13
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Yu W, Jacobson DL, Williams PL, Patel K, Geffner ME, Van Dyke RB, Kacanek D, DiMeglio LA, Jao J. Growth patterns of uninfected children born to women living with perinatally versus nonperinatally acquired HIV. AIDS 2022; 36:593-603. [PMID: 34860195 PMCID: PMC8881380 DOI: 10.1097/qad.0000000000003136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to compare long-term growth between HIV-exposed uninfected children (CHEU) born to women with perinatally acquired HIV (CHEU-PHIV) and CHEU born to women with nonperinatally acquired HIV (CHEU-NPHIV). DESIGN A longitudinal analysis of anthropometric measurements from a U.S.-based multisite prospective cohort study enrolling CHEU and their mothers since April 2007. METHODS CHEU were evaluated for growth annually from birth through age 5 and again at age 7 years. Z-scores were calculated using U.S. growth references for weight (WTZ), height (HTZ), and weight-for-length or BMI-for-age (WLZ/BMIZ). Mid-upper arm circumference (MUACZ) and triceps skinfold thickness (TSFZ) Z-scores were obtained from ages 1 and 2, respectively, through age 7 years. Piecewise mixed-effects models, overall and stratified by race and sex, were fit to assess differential growth patterns across age by maternal PHIV status. RESULTS One thousand four hundred fifty-four singleton infants (286 CHEU-PHIV and 1168 CHEU-NPHIV) were included. CHEU-PHIV had slower growth rates than CHEU-NPHIV for WTZ and WLZ/BMIZ at earlier ages and continued to have lower mean WTZ [-0.27, 95% confidence interval (95% CI): -0.50, -0.04] and WLZ/BMIZ (-0.39, 95% CI: -0.67, -0.11) through age 7. Among non-Black boys, CHEU-PHIV had slightly lower WTZ and WLZ/BMIZ at birth than CHEU-NPHIV and these growth deficits persisted through age 7 years. CONCLUSION Compared with CHEU-NPHIV, CHEU-PHIV had diminished growth in early childhood with differences most pronounced among non-Black male children. Further longitudinal follow-up of CHEU-PHIV into young adulthood is needed to understand whether these early effects of maternal PHIV status on growth persist and have other health consequences.
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Affiliation(s)
- Wendy Yu
- Center for Biostatistics in AIDS Research
| | | | - Paige L Williams
- Center for Biostatistics in AIDS Research, Departments of Biostatistics and Epidemiology
| | - Kunjal Patel
- Center for Biostatistics in AIDS Research, Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Mitchell E Geffner
- The Saban Research Institute of Children's Hospital Los Angeles, Keck School of Medicine of USC, Los Angeles, California
| | - Russell B Van Dyke
- Tulane University School of Medicine, Department of Pediatrics, New Orleans, Los Angeles
| | | | - Linda A DiMeglio
- Indiana University School of Medicine, Department of Pediatrics, Indianapolis, Indiana
| | - Jennifer Jao
- Northwestern University Feinberg School of Medicine, Department of Pediatrics, Department of Medicine, Chicago, Illinois, USA
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14
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Canetti D, Muccini C, Spagnuolo V, Galli L, Poli A, Gianotti N, Feasi M, Castagna A. Achieving virological control in pan-resistant HIV-1 infection: A case series. EBioMedicine 2022; 77:103906. [PMID: 35255457 PMCID: PMC8897623 DOI: 10.1016/j.ebiom.2022.103906] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 02/10/2022] [Accepted: 02/14/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND HIV-1 pan-resistance refers to a reduced susceptibility to nucleoside reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors, protease inhibitors and integrase strand tranfer inhibitors. Although still anecdotal, its management remains a concern both for affected people living with HIV (PLWH) and for public health. METHODS We described genotypic resistance testing (GRT) of three PLWH with a documented poor virological response to previous antiretroviral therapies, who started ibalizumab, an anti-CD4 monoclonal antibody, combined with an optimized background therapy. Both historical and most recent GRT on plasma RNA and peripheral blood mononuclear cell DNA were interpreted according to the Stanford HIVDb version 9.0 (last updated on 22 February, 2021). After the switch to a regimen including the monoclonal antibody, HIV-1 RNA has been quantified biweekly (PCR Cobas® HIV-1 test 6800 Systems, Roche Diagnostics). Follow-up was censored at data freezing (16 January, 2021). FINDINGS We report findings from heavily treatment-experienced PLWH with a pan-resistant HIV-1 infection, who achieved virological control once introduced injections of ibalizumab, that is free from cross-resistance with all the antiretroviral drugs available and ensures patient adherence due to a close monitoring attributable to the route of administration, combined with recycled enfuvirtide and an optimized background regimen, selected on the basis of an accurate evaluation of resistance mutations. INTERPRETATION In these cases, this new approach has revealed to be a turning point in achieving virological control. FUNDING None, this research was supported by internal funding.
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Affiliation(s)
- Diana Canetti
- Department of Infectious Diseases, IRCCS San Raffaele Scientific Institute, Via Stamira D'Ancona 20, Milan 20127, Italy.
| | - Camilla Muccini
- Department of Infectious Diseases, IRCCS San Raffaele Scientific Institute, Via Stamira D'Ancona 20, Milan 20127, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | | | - Laura Galli
- Department of Infectious Diseases, IRCCS San Raffaele Scientific Institute, Via Stamira D'Ancona 20, Milan 20127, Italy
| | - Andrea Poli
- Department of Infectious Diseases, IRCCS San Raffaele Scientific Institute, Via Stamira D'Ancona 20, Milan 20127, Italy
| | - Nicola Gianotti
- Department of Infectious Diseases, IRCCS San Raffaele Scientific Institute, Via Stamira D'Ancona 20, Milan 20127, Italy
| | | | - Antonella Castagna
- Department of Infectious Diseases, IRCCS San Raffaele Scientific Institute, Via Stamira D'Ancona 20, Milan 20127, Italy; Vita-Salute San Raffaele University, Milan, Italy
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15
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Bartlett AW, Sudjaritruk T, Mohamed TJ, Anugulruengkit S, Kumarasamy N, Phongsamart W, Ly PS, Truong KH, Van Nguyen L, Do VC, Ounchanum P, Puthanakit T, Chokephaibulkit K, Lumbiganon P, Kurniati N, Nik Yusoff NK, Wati DK, Sohn AH, Kariminia A. Identification, Management, and Outcomes of Combination Antiretroviral Treatment Failure in Adolescents With Perinatal Human Immunodeficiency Virus Infection in Asia. Clin Infect Dis 2021; 73:e1919-e1926. [PMID: 32589711 PMCID: PMC8492217 DOI: 10.1093/cid/ciaa872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 06/21/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Combination antiretroviral therapy (cART) failure is a major threat to human immunodeficiency virus (HIV) programs, with implications for individual- and population-level outcomes. Adolescents with perinatally acquired HIV infection (PHIVA) should be a focus for treatment failure given their poorer outcomes compared to children and adults. METHODS Data (2014-2018) from a regional cohort of Asian PHIVA who received at least 6 months of continuous cART were analyzed. Treatment failure was defined according to World Health Organization criteria. Descriptive analyses were used to report treatment failure and subsequent management and evaluate postfailure CD4 count and viral load trends. Kaplan-Meier survival analyses were used to compare the cumulative incidence of death and loss to follow-up (LTFU) by treatment failure status. RESULTS A total 3196 PHIVA were included in the analysis with a median follow-up period of 3.0 years, of whom 230 (7.2%) had experienced 292 treatment failure events (161 virologic, 128 immunologic, 11 clinical) at a rate of 3.78 per 100 person-years. Of the 292 treatment failure events, 31 (10.6%) had a subsequent cART switch within 6 months, which resulted in better immunologic and virologic outcomes compared to those who did not switch cART. The 5-year cumulative incidence of death and LTFU following treatment failure was 18.5% compared to 10.1% without treatment failure. CONCLUSIONS Improved implementation of virologic monitoring is required to realize the benefits of virologic determination of cART failure. There is a need to address issues related to accessibility to subsequent cART regimens, poor adherence limiting scope to switch regimens, and the role of antiretroviral resistance testing.
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Affiliation(s)
- Adam W Bartlett
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Tavitiya Sudjaritruk
- Department of Pediatrics, Faculty of Medicine, and Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | | | - Suvaporn Anugulruengkit
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence for Pediatric Infectious Diseases and Vaccines, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Nagalingeswaran Kumarasamy
- Chennai Antiviral Research and Treatment Clinical Research Site, VHS-Infectious Diseases Medical Centre, Voluntary Health Services, Chennai, India
| | - Wanatpreeya Phongsamart
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Penh Sun Ly
- National Centre for HIV/AIDS, Dermatology and Sexually Transmitted Diseases, Phnom Penh, Cambodia
| | | | | | - Viet Chau Do
- Children’s Hospital 2, Ho Chi Minh City, Vietnam
| | | | - Thanyawee Puthanakit
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence for Pediatric Infectious Diseases and Vaccines, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kulkanya Chokephaibulkit
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pagakrong Lumbiganon
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Nia Kurniati
- Cipto Mangunkusumo–Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | | | | | - Annette H Sohn
- TREAT Asia, amfAR—the Foundation for AIDS Research, Bangkok, Thailand
| | - Azar Kariminia
- Kirby Institute, University of New South Wales, Sydney, Australia
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16
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Dassi Tchoupa Revegue MH, Takassi UE, Tanoh Eboua F, Desmonde S, Amoussou-Bouah UB, Bakai TA, Jesson J, Dahourou DL, Malateste K, Aka-Dago-Akribi H, Raynaud JP, Arrivé E, Leroy V. 24-Month Clinical, Immuno-Virological Outcomes, and HIV Status Disclosure in Adolescents Living With Perinatally-Acquired HIV in the IeDEA-COHADO Cohort in Togo and Côte d'Ivoire, 2015-2017. Front Pediatr 2021; 9:582883. [PMID: 34277512 PMCID: PMC8278018 DOI: 10.3389/fped.2021.582883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 05/27/2021] [Indexed: 01/08/2023] Open
Abstract
Background: Adolescents living with perinatally-acquired HIV (APHIV) face challenges including HIV serostatus disclosure. We assessed their 24-month outcomes in relation to the disclosure of their own HIV serostatus. Methods: Nested within the International epidemiologic Database to Evaluate AIDS pediatric West African prospective cohort (IeDEA pWADA), the COHADO cohort included antiretroviral (ART)-treated APHIV aged 10-19 years, enrolled in HIV care before the age of 10 years, in Abidjan (Côte d'Ivoire) and Lomé (Togo) in 2015. We measured the HIV serostatus disclosure at baseline and after 24 months and analyzed its association with a favorable combined 24-month outcome using logistic regression. The 24-month combined clinical immuno-virological outcome was defined as unfavorable when either death, loss to follow-up, progression to WHO-AIDS stage, a decrease of CD4 count >10% compared to baseline, or a detectable viral load (VL > 50 copies/mL) occurred at 24 months. Results: Overall, 209 APHIV were included (51.6% = Abidjan, 54.5% = females). At inclusion, the median CD4 cell count was 521/mm 3 [IQR (281-757)]; 29.6% had a VL measurement, of whom, 3.2% were virologically suppressed. APHIV were younger in Lomé {median age: 12 years [interquartile range (IQR): 11-15]} compared to Abidjan [14 years (IQR: 12-15, p = 0.01)]. Full HIV-disclosure increased from 41.6% at inclusion to 74.1% after 24 months. After 24 months of follow-up, six (2.9%) died, eight (3.8%) were lost to follow-up, and four (1.9%) were transferred out. Overall, 73.7% did not progress to the WHO-AIDS stage, and 62.7% had a CD4 count above (±10%) of the baseline value (48.6% in Abidjan vs. 69.0% in Lomé, p < 0.001). Among the 83.7% with VL measurement, 48.8% were virologically suppressed (Abidjan: 45.4%, Lomé: 52.5%, p <0.01). The 24-month combined outcome was favorable for 45% (29.6% in Abidjan and 61.4% in Lomé, p < 0.01). Adjusted for baseline variables, the 24-month outcome was worse in Lomé in those who had been disclosed for >2 years compared to those who had not been disclosed to [aOR = 0.21, 95% CI (0.05-0.84), p = 0.03]. Conclusions: The frequency of HIV-disclosure improved over time and differed across countries but remained low among West African APHIV. Overall, the 24-month outcomes were poor. Disclosure before the study was a marker of a poor 24-month outcome in Lomé. Context-specific responses are urgently needed to improve adolescent care and reach the UNAIDS 90% target of virological success.
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Affiliation(s)
- Marc Harris Dassi Tchoupa Revegue
- Center for Epidemiology and Research in POPulation Health (CERPOP), Inserm, Université de Toulouse, Université Paul Sabatier, Toulouse, France
| | - Unoo Elom Takassi
- Department of Pediatrics, Centre Hospitalier Universitaire Sylvanus Olympio, Lomé, Togo
| | - François Tanoh Eboua
- Department of Pediatrics, Centre Hospitalier Universitaire de Yopougon, Abidjan, Côte d'Ivoire
| | - Sophie Desmonde
- Center for Epidemiology and Research in POPulation Health (CERPOP), Inserm, Université de Toulouse, Université Paul Sabatier, Toulouse, France
| | | | - Tchaa Abalo Bakai
- Department of Pediatrics, Centre Hospitalier Universitaire Sylvanus Olympio, Lomé, Togo
- Department of Pediatrics, Centre Hospitalier Universitaire de Yopougon, Abidjan, Côte d'Ivoire
| | - Julie Jesson
- Center for Epidemiology and Research in POPulation Health (CERPOP), Inserm, Université de Toulouse, Université Paul Sabatier, Toulouse, France
| | - Désiré Lucien Dahourou
- Département Biomédical et de Santé Publique, Institut de Recherche en Sciences de la Santé (IRSS/CNRST), Ouagadougou, Burkina Faso
- Centre Muraz, Bobo-Dioulasso, Burkina Faso
| | - Karen Malateste
- Inserm U1219-Epidemiologie-Biostatistique, Université de Bordeaux, Bordeaux, France
| | | | - Jean-Philippe Raynaud
- Center for Epidemiology and Research in POPulation Health (CERPOP), Inserm, Université de Toulouse, Université Paul Sabatier, Toulouse, France
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, CHU de Toulouse, Toulouse, France
| | - Elise Arrivé
- Inserm U1219-Epidemiologie-Biostatistique, Université de Bordeaux, Bordeaux, France
| | - Valériane Leroy
- Center for Epidemiology and Research in POPulation Health (CERPOP), Inserm, Université de Toulouse, Université Paul Sabatier, Toulouse, France
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Virologic response of adolescents living with perinatally acquired HIV receiving antiretroviral therapy in the period of early adolescence (10-14 years) in South Africa. AIDS 2021; 35:971-978. [PMID: 33492836 PMCID: PMC8026711 DOI: 10.1097/qad.0000000000002818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND OBJECTIVES Adolescents living with perinatally acquired HIV (ALPHIV) on antiretroviral therapy (ART) have been noted to have poorer adherence, retention and virologic control compared to adolescents with non-perinatally acquired HIV, children or adults. We aimed to describe and examine factors associated with longitudinal virologic response during early adolescence. DESIGN A retrospective cohort study. METHODS We included ALPHIV who initiated ART before age 9.5 years in South African cohorts of the International epidemiology Database to Evaluate AIDS-Southern Africa (IeDEA-SA) collaboration (2004-2016); with viral load (VL) values <400 copies/ml at age 10 years and at least one VL measurement after age 10 years. We used a log-linear quantile mixed model to assess factors associated with elevated (75th quantile) VLs. RESULTS We included 4396 ALPHIV, 50.7% were male, with median (interquartile range) age at ART start of 6.5 (4.5, 8.1) years. Of these, 74.9% were on a non-nucleoside reverse transcriptase inhibitor (NNRTI) at age 10 years. After adjusting for other patient characteristics, the 75th quantile VLs increased with increasing age being 3.13-fold (95% CI 2.66, 3.68) higher at age 14 versus age 10, were 3.25-fold (95% CI 2.81, 3.75) higher for patients on second-line protease-inhibitor and 1.81-fold for second-line NNRTI-based regimens (versus first-line NNRTI-based regimens). There was no difference by sex. CONCLUSIONS As adolescents age between 10 and 14 years, they are increasingly likely to experience higher VL values, particularly if receiving second-line protease inhibitor or NNRTI-based regimens, which warrant adherence support interventions.
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Yusuf H, Agwu A. Adolescents and young adults with early acquired HIV infection in the united states: unique challenges in treatment and secondary prevention. Expert Rev Anti Infect Ther 2021; 19:457-471. [PMID: 32990092 PMCID: PMC8084860 DOI: 10.1080/14787210.2021.1829473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/24/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Worldwide, children who acquired human immunodeficiency virus (HIV) at an early age, either perinatally or through blood transfusion, are reaching adolescence and adulthood due to successful antiretroviral treatment (ART). While many are thriving, a significant proportion face unprecedented multilevel challenges that can affect their long-term outcomes. Specifically, longstanding and poorly controlled HIV resulting from inadequate early regimens and nonadherence, along with the toxicities of some ART agents, can predispose them to sequelae including HIV-associated complications and other comorbidities. AREAS COVERED This paper reviews and summarizes the unique issues facing adolescents and young adults with early acquired HIV (AYA-EAHIV), including ART challenges, emerging comorbidities, and complications, including mental health comorbidities, secondary prevention, and transition from pediatric/adolescent to adult care. EXPERT OPINION AYA-EAHIV are a special population that have lived their entire lives with the physical and psychological toll of HIV mandating targeted and purposeful approaches to optimize their management and outcomes. Multifaceted inclusive and context-specific approaches focusing on heightened research, risk reduction interventions, and 'outside the box' thinking will be required to optimize treatment and reduce morbidity and mortality.
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Affiliation(s)
- Hasiya Yusuf
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Allison Agwu
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Bitwale NZ, Mnzava DP, Kimaro FD, Jacob T, Mpondo BCT, Jumanne S. Prevalence and Factors Associated With Virological Treatment Failure Among Children and Adolescents on Antiretroviral Therapy Attending HIV/AIDS Care and Treatment Clinics in Dodoma Municipality, Central Tanzania. J Pediatric Infect Dis Soc 2021; 10:131-140. [PMID: 32463083 DOI: 10.1093/jpids/piaa030] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 04/17/2020] [Indexed: 11/13/2022]
Abstract
BACKGROUND As the World Health Organization (WHO) and its joint partners such as USAIDS target achieving 90% sustained virological suppression among children and adolescents living with Human Immunodeficience Virus (HIV)/AIDS, it is imperative to elucidate the current prevalence and factors associated with virological treatment failure for formulation of appropriate strategies. This study was conducted determine the prevalence and factors associated with virological treatment failure among children and adolescents with HIV/AIDS on antiretroviral therapy (ART) attending HIV/AIDS care clinics in Dodoma, Central Tanzania. METHODS This was a cross-sectional study of children aged 1-19 years attending 3 HIV/AIDS care clinics in Dodoma (central Tanzania) from November 2018 to February 2019. Sociodemographic and clinical factors were documented, HIV viral load and CD4+ T lymphocytes were evaluated for children on ART for ≥6 months. The primary outcomes were the prevalence and factors associated with viralogic treatment failure. RESULTS Of 300 children enrolled, 102 (34%) had virological treatment failure. Poor adherence to ART (adjusted odds ratio [AOR] = 3.221; 95% confidence interval [CI], 1.867-5.558; P = .032), nevirapine regimen (AOR = 3.185; 95% CI, 1.473-6.886; P ≤ .001), not using cotrimoxazole prophylaxis (AOR = 25.56; 95% CI, 3.15-27.55; P = .002) and nondisclosure of HIV status to others (AOR = 7.741; 95% CI, 2.351-25.489; P = .001) were independently associated with virological treatment failure. CONCLUSIONS Current prevalence of virological treatment failure among children and adolescents living with HIV on ART remain high. Factors such as ART adherence, nevirapine based regimen, HIV status disclosure to those caring for the child need to be addressed to achieve sustained virological suppression.
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Affiliation(s)
- Niyonziza Z Bitwale
- Department of Paediatrics & Child Health, University of Dodoma, Dodoma, Tanzania
| | - David P Mnzava
- Department of Paediatrics & Child Health, Dodoma Regional Referral Hospital, Dodoma, Tanzania
| | - Francisca D Kimaro
- Department of Paediatrics & Child Health, University of Dodoma, Dodoma, Tanzania
| | - Theopista Jacob
- Department of Paediatrics & Child Health, Mbeya Zonal Referral Hospital, Mbeya, Tanzania
| | | | - Shakilu Jumanne
- Department of Paediatrics & Child Health, University of Dodoma, Dodoma, Tanzania
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Kibalama Ssemambo P, Nalubega-Mboowa MG, Owora A, Serunjogi R, Kironde S, Nakabuye S, Ssozi F, Nannyonga M, Musoke P, Barlow-Mosha L. Virologic response of treatment experienced HIV-infected Ugandan children and adolescents on NNRTI based first-line regimen, previously monitored without viral load. BMC Pediatr 2021; 21:139. [PMID: 33752636 PMCID: PMC7983217 DOI: 10.1186/s12887-021-02608-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 03/11/2021] [Indexed: 11/18/2022] Open
Abstract
Background Many HIV-infected African children gained access to antiretroviral treatment (ART) through expansion of PEPFAR programs since 2004 and introduction of “Test and Treat” WHO guidelines in 2015. As ART access increases and children transition from adolescence to adulthood, treatment failure is inevitable. Viral load (VL) monitoring in Uganda was introduced in 2016 replacing clinical monitoring. However, there’s limited data on the comparative effectiveness of these two strategies among HIV-infected children in resource-limited settings (RLS). Methods HIV-infected Ugandan children aged 1–12 years from HIV-care programs with > 1 year of first-line ART using only immunologic and clinical criteria to monitor response to treatment were screened in 2010. Eligible children were stratified by VL ≤ 400 and > 400 copies/ml randomized to clinical and immunological (control) versus clinical, immunological and VL monitoring to determine treatment failure with follow-up at 12, 24, 36, and 48 weeks. Plasma VL was analyzed retrospectively for controls. Mixed-effects logistic regression models were used to compare the prevalence of viral suppression between study arms and identify factors associated with viral suppression. Results At baseline all children (n = 142) were on NNRTI based ART (75% Nevirapine, 25% efavirenz). One third of ART-experienced children had detectable VL at baseline despite high CD4%. Median age was 6 years (interquartile range [IQR]: 5–9) and 43% were female. Overall, the odds of viral suppression were not different between study arms: (arm by week interaction, p = 0.63), adjusted odds ratio [aOR]: 1.07; 95%CI: 0.53, 2.17, p = 0.57) and did not change over time (aOR: 0 vs 24 week: 1.15; 95% CI: 0.91, 1.46, p = 0.24 and 0 vs 48 weeks: 1.26; 95%CI: 0.92, 1.74, p = 0.15). Longer duration of a child’s ART exposure was associated with lower odds of viral suppression (aOR: 0.61; 95% CI: 0.42, 0.87, p < .01). Only 13% (9/71) of children with virologic failure were switched to second-line ART, in spite of access to real-time VL. Conclusion With increasing ART exposure, viral load monitoring is critical for early detection of treatment failure in RLS. Clinicians need to make timely informed decisions to switch failing children to second-line ART. Trial registration ClinicalTrials.gov NCT04489953, 28 Jul 2020. Retrospectively registered. (https://register.clinicaltrials.gov).
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Affiliation(s)
- Phionah Kibalama Ssemambo
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Upper Mulago Hill Road, Mulago, P.O.BOX 23491, Kampala, Uganda.
| | - Mary Gorrethy Nalubega-Mboowa
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Upper Mulago Hill Road, Mulago, P.O.BOX 23491, Kampala, Uganda.,Nsambya Home Care Project (NHC), Kampala, Uganda.,Clarke International University (Formerly IHSU), Namuwongo, Kampala, Uganda
| | - Arthur Owora
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Upper Mulago Hill Road, Mulago, P.O.BOX 23491, Kampala, Uganda.,Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Indiana, USA
| | - Robert Serunjogi
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Upper Mulago Hill Road, Mulago, P.O.BOX 23491, Kampala, Uganda
| | | | - Sarah Nakabuye
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Upper Mulago Hill Road, Mulago, P.O.BOX 23491, Kampala, Uganda
| | | | | | - Philippa Musoke
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Upper Mulago Hill Road, Mulago, P.O.BOX 23491, Kampala, Uganda.,Department of Paediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Linda Barlow-Mosha
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Upper Mulago Hill Road, Mulago, P.O.BOX 23491, Kampala, Uganda
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Beltrán-Pavez C, Gutiérrez-López M, Rubio-Garrido M, Valadés-Alcaraz A, Prieto L, Ramos JT, Jiménez De Ory S, Navarro M, Díez-Romero C, Pulido F, Valencia E, Holguín Á. Virological outcome among HIV infected patients transferred from pediatric care to adult units in Madrid, Spain (1997-2017). Sci Rep 2020; 10:16891. [PMID: 33037235 PMCID: PMC7547007 DOI: 10.1038/s41598-020-70861-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/27/2020] [Indexed: 12/24/2022] Open
Abstract
The aim of this transversal study was to describe the virological and immunological features of HIV-infected youths transferred from pediatric to adult care units since 1997 vs. the non-transferred patients from the Madrid Cohort of HIV-infected children and adolescents in Spain. We included 106 non-transferred and 184 transferred patients under clinical follow-up in 17 public hospitals in Madrid by the end of December 2017. Virological and immunological outcomes were compared in transferred vs. non-transferred patients. ART drug resistance mutations and HIV-variants were analyzed in all subjects with available resistance pol genotypes and/or genotypic resistance profiles. Among the study cohort, 133 (72.3%) of 184 transferred and 75 (70.7%) of 106 non-transferred patients had available resistance genotypes. Most (88.9%) of transferred had ART experience at sampling. A third (33.3%) had had a triple-class experience. Acquired drug resistance (ADR) prevalence was significantly higher in pretreated transferred than non-transferred patients (71.8% vs. 44%; p = 0.0009), mainly to NRTI (72.8% vs. 31.1%; p < 0.0001) and PI (29.1% vs. 12%; p = 0.0262). HIV-1 non-B variants were less frequent in transferred vs. non-transferred (6.9% vs. 32%; p < 0.0001). In conclusion, the frequent resistant genotypes found in transferred youths justifies the reinforcement of HIV resistance monitoring after the transition to avoid future therapeutic failures.
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Affiliation(s)
- Carolina Beltrán-Pavez
- HIV-1 Molecular Epidemiology Laboratory, Microbiology and Parasitology Department, Hospital Ramón y Cajal-IRYCIS and CIBEREsp-RITIP-CoRISPe, Carretera de Colmenar Viejo, Km. 9,100. -2D, 28034, Madrid, Spain
| | - Miguel Gutiérrez-López
- HIV-1 Molecular Epidemiology Laboratory, Microbiology and Parasitology Department, Hospital Ramón y Cajal-IRYCIS and CIBEREsp-RITIP-CoRISPe, Carretera de Colmenar Viejo, Km. 9,100. -2D, 28034, Madrid, Spain
| | - Marina Rubio-Garrido
- HIV-1 Molecular Epidemiology Laboratory, Microbiology and Parasitology Department, Hospital Ramón y Cajal-IRYCIS and CIBEREsp-RITIP-CoRISPe, Carretera de Colmenar Viejo, Km. 9,100. -2D, 28034, Madrid, Spain
| | - Ana Valadés-Alcaraz
- HIV-1 Molecular Epidemiology Laboratory, Microbiology and Parasitology Department, Hospital Ramón y Cajal-IRYCIS and CIBEREsp-RITIP-CoRISPe, Carretera de Colmenar Viejo, Km. 9,100. -2D, 28034, Madrid, Spain
| | - Luis Prieto
- Department of Infectious Diseases, Hospital 12 de Octubre, RIS, Madrid, Spain
| | - José Tomás Ramos
- Department of Infectious Diseases, Hospital Clínico Universitario and Universidad Complutense-CoRISpe, Madrid, Spain
| | - Santiago Jiménez De Ory
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IisGM), CoRISpe, Madrid, Spain
| | - Marisa Navarro
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IisGM), CoRISpe, Madrid, Spain
| | - Cristina Díez-Romero
- Department of Infectious Diseases, Hospital Gregorio Marañón, RIS, Madrid, Spain
| | - Federico Pulido
- Hospital Universitario 12 de Octubre, imas12, UCM, Madrid, Spain
| | - Eulalia Valencia
- HIV Unit, Internal Medicine Service, Hospital Universitario La Paz-IdiPAZ, Madrid, Spain
| | - África Holguín
- HIV-1 Molecular Epidemiology Laboratory, Microbiology and Parasitology Department, Hospital Ramón y Cajal-IRYCIS and CIBEREsp-RITIP-CoRISPe, Carretera de Colmenar Viejo, Km. 9,100. -2D, 28034, Madrid, Spain.
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Bernays S, Lanyon C, Paparini S. Adolescents Living With HIV: Checking Unhelpful Terminology. J Adolesc Health 2020; 67:477-478. [PMID: 32792257 DOI: 10.1016/j.jadohealth.2020.07.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/12/2020] [Accepted: 07/12/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Sarah Bernays
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia; Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Chloe Lanyon
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Sara Paparini
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, University of Oxford, Oxford, United Kingdom
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Pan-resistant HIV-1 emergence in the era of integrase strand-transfer inhibitors: a case report. THE LANCET MICROBE 2020; 1:e130-e135. [DOI: 10.1016/s2666-5247(20)30006-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/17/2020] [Accepted: 04/03/2020] [Indexed: 12/13/2022] Open
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Foster C, Ayers S, Fidler S. Antiretroviral adherence for adolescents growing up with HIV: understanding real life, drug delivery and forgiveness. Ther Adv Infect Dis 2020; 7:2049936120920177. [PMID: 32523693 PMCID: PMC7236389 DOI: 10.1177/2049936120920177] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 03/22/2020] [Indexed: 12/18/2022] Open
Abstract
Poorer adherence to medication is normal in adolescence and is one of a range of risk-taking behaviours common during a developmental stage that encompasses enormous cognitive, physical, sexual, social and emotional change. For adolescents living with human immunodeficiency virus (HIV) infection, poor adherence to antiretroviral therapy (ART) confers two significant challenges: poor health, but also the specific additional burden of onward transmission to partners. Late adolescence (15-19 years) is the only age group where HIV-associated mortality is rising, driven by poor adherence to ART and lack of access to second-line therapy, particularly amongst surviving perinatally infected young people. A previous lack of well-powered randomised multimodal behavioural ART adherence interventions specifically targeting adolescents is now being addressed and ongoing studies registered to ClinicalTrials.gov are described in the context of previous data. Accepting that despite enhanced support, some adolescents will continue to struggle with adherence, we must address how best to use existing ART agents to reduce mortality and allow adolescents the time to mature into adult life. Single-tablet regimens with a high genetic barrier to resistance based on integrase inhibitors and boosted protease inhibitors exist, but global access, in resource limited settings of young people living with HIV reside, is limited. Pragmatically, such regimens tolerate the intermittent adherence so characteristic of adolescence, preserving immune function, without the rapid evolution of resistance. The potential role of long-acting injectable ART, specifically cabotegravir and rilpivirine, is discussed and future strategies including ultra-long-acting drug-delivery systems and broadly neutralising monoclonal antibodies explored.
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Affiliation(s)
- Caroline Foster
- The 900 Clinic, Imperial College Healthcare NHS Trust, London W2 1NY, UK
| | - Sara Ayers
- Imperial College Healthcare NHS Trust, London, UK
| | - Sarah Fidler
- Imperial College Healthcare NHS Trust, London, UK
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Anderson K, Muloiwa R, Davies MA. Long-term outcomes in perinatally HIV-infected adolescents and young adults on antiretroviral therapy: a review of South African and global literature. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2020; 19:1-12. [PMID: 32122278 DOI: 10.2989/16085906.2019.1676802] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Paediatric antiretroviral programmes have been implemented globally for more than a decade, yet information on long-term treatment outcomes in perinatally HIV-infected adolescents is limited. Published literature on long-term treatment outcomes was reviewed, including virologic, immunologic and growth outcomes, as well as drug resistance and factors associated with drug resistance. Outcomes were compared between high-income countries and low- and middle-income countries (LMIC), with additional focus on South Africa, the country with the biggest HIV epidemic in the world and the largest treatment programme. Treatment outcomes varied but viral suppression results globally were generally concerning. No studies from LMIC have reported on outcomes after >10 years follow-up, demonstrating that further studies are needed.
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Affiliation(s)
- Kim Anderson
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Rudzani Muloiwa
- Department of Paediatrics, Groote Schuur Hospital, Cape Town, South Africa
| | - Mary-Ann Davies
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Clinical outcomes post transition to adult services in young adults with perinatally acquired HIV infection: mortality, retention in care and viral suppression. AIDS 2020; 34:261-266. [PMID: 31651427 DOI: 10.1097/qad.0000000000002410] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Adolescence is the only age group globally where HIV-associated mortality is rising, with poorer outcomes at all stages of the care cascade compared with adults. We examined post transition outcomes for young adults living with perinatal HIV. DESIGN Retrospective cohort analysis. SETTING A tertiary Youth Friendly Service London, UK. PARTICIPANTS A total of 180 young adults living with perinatal HIV registered between 1 January 2006 and 31 December 2017 contributed 921 person-years of follow-up post transition to adult services. INTERVENTION Youth Friendly Service with multidisciplinary care and walk-in access. MAIN OUTCOME MEASURES Mortality, morbidity, retention in care, antiretroviral therapy (ART) uptake and HIV-viral load suppression. Crude incidence rates are reported per 1000 person-years. RESULTS Of 180 youth registered, four (2.2%) died, 14 (7.8%) transferred care and four (2.2%) were lost to follow-up. For the 158 retained in care, the median age was 22.9 years [interquartile ranges (IQR) 20.3-25.4], 56% were female, 85% Black African, with a median length of follow-up in adult care of 5.5 years (IQR 2.9-7.3). 157 (99.4%) ever received an ART prescription, 127/157 (81%) with a latest HIV-viral load less than 200 copies RNA/ml, median CD4 cell count of 626 cells/μl (IQR 441-820). The all-cause mortality was 4.3/1000 person-years [95% confidence interval (CI) 1.2-11.1], 10 fold the aged-matched UK HIV-negative population [0.43/1000 person-years (95% CI 0.41-0.44)]. Post transition, 17/180 (9.4%) developed a new AIDS diagnosis; crude incidence rates 18.5/1000 person-years (95% CI 10.8-29.6). CONCLUSION While this youth-friendly multidisciplinary service achieved high engagement and coverage of suppressive ART, mortality remains markedly increased compared with the general UK population.
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Prevalence of acquired resistance mutations in a large cohort of perinatally infected HIV-1 patients. Clin Microbiol Infect 2019; 25:1443-1446. [DOI: 10.1016/j.cmi.2019.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 06/28/2019] [Accepted: 07/02/2019] [Indexed: 12/25/2022]
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Early and Late Virologic Failure After Virologic Suppression in HIV-Infected Asian Children and Adolescents. J Acquir Immune Defic Syndr 2019; 80:308-315. [PMID: 30531299 DOI: 10.1097/qai.0000000000001921] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Virologic failure is a major threat to maintaining effective combination antiretroviral therapy, especially for children in need of lifelong treatment. With efforts to expand access to HIV viral load testing, our understanding of pediatric virologic failure is evolving. SETTING An Asian cohort in 16 pediatric HIV services across 6 countries. METHODS From 2005 to 2014, patients younger than 20 years who achieved virologic suppression and had subsequent viral load testing were included. Early virologic failure was defined as a HIV RNA ≥1000 copies per milliliter within 12 months of virologic suppression, and late virologic as a HIV RNA ≥1000 copies per milliliter after 12 months following virologic suppression. Characteristics at combination antiretroviral therapy initiation and virologic suppression were described, and a competing risk time-to-event analysis was used to determine cumulative incidence of virologic failure and factors at virologic suppression associated with early and late virologic failure. RESULTS Of 1105 included in the analysis, 182 (17.9%) experienced virologic failure. The median age at virologic suppression was 6.9 years, and the median time to virologic failure was 24.6 months after virologic suppression. The incidence rate for a first virologic failure event was 3.3 per 100 person-years. Factors at virologic suppression associated with late virologic failure included older age, mostly rural clinic setting, tuberculosis, protease inhibitor-based regimens, and early virologic failure. No risk factors were identified for early virologic failure. CONCLUSIONS Around 1 in 5 experienced virologic failure in our cohort after achieving virologic suppression. Targeted interventions to manage complex treatment scenarios, including adolescents, tuberculosis coinfection, and those with poor virologic control are required.
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Simulation Modeling and Metamodeling to Inform National and International HIV Policies for Children and Adolescents. J Acquir Immune Defic Syndr 2019; 78 Suppl 1:S49-S57. [PMID: 29994920 PMCID: PMC6042862 DOI: 10.1097/qai.0000000000001749] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Objective and Approach: Computer-based simulation models serve an important purpose in informing HIV care for children and adolescents. We review current model-based approaches to informing pediatric and adolescent HIV estimates and guidelines. Findings: Clinical disease simulation models and epidemiologic models are used to inform global and regional estimates of numbers of children and adolescents living with HIV and in need of antiretroviral therapy, to develop normative guidelines addressing strategies for diagnosis and treatment of HIV in children, and to forecast future need for pediatric and adolescent antiretroviral therapy formulations and commodities. To improve current model-generated estimates and policy recommendations, better country-level and regional-level data are needed about children living with HIV, as are improved data about survival and treatment outcomes for children with perinatal HIV infection as they age into adolescence and adulthood. In addition, novel metamodeling and value of information methods are being developed to improve the transparency of model methods and results, as well as to allow users to more easily tailor model-based analyses to their own settings. Conclusions: Substantial progress has been made in using models to estimate the size of the pediatric and adolescent HIV epidemic, to inform the development of guidelines for children and adolescents affected by HIV, and to support targeted implementation of policy recommendations to maximize impact. Ongoing work will address key limitations and further improve these model-based projections.
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Abstract
Observational data characterizing the pediatric and adolescent HIV epidemics in real-world settings are critical to informing clinical guidelines, governmental HIV programs, and donor prioritization. Global expertise in curating and analyzing these data has been expanding, with increasingly robust collaborations and the identification of gaps in existing surveillance capacity. In this commentary, we describe existing sources of observational data for children and youth living with HIV, focusing on larger regional and global research cohorts, and targeted surveillance studies and programs. Observational data are valuable resources to cross-validate other research and to monitor the impact of changing HIV program policies. Observational studies were among the first to highlight the growing population of children surviving perinatal HIV and transitioning to adolescence and young adulthood, and have raised serious concerns about high rates of treatment failure, loss to follow-up, and death among older perinatally infected youth. The use of observational data to inform modeling of the current global epidemic, predict future patterns of the youth cascade, and facilitate antiretroviral forecasting are critical priorities and key end products of observational HIV research. Greater investments into data infrastructure are needed at the local level to improve data quality and at the global level to faciliate reliable interpretation of the evolving patterns of the pediatric and youth epidemics. Although this includes harmonized data forms, use of unique patient identifiers to allow for data linkages across routine data sets and electronic medical record systems, and competent data managers and analysts are essential to make optimal use of the data collected.
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HIV-infected youths transitioning from pediatric to adult outpatient care in a teaching tertiary care hospital in São Paulo city, Brazil. Braz J Infect Dis 2019; 23:291-297. [PMID: 31479628 PMCID: PMC9427935 DOI: 10.1016/j.bjid.2019.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 07/04/2019] [Accepted: 07/21/2019] [Indexed: 11/20/2022] Open
Abstract
Background HIV-infected children surviving until adulthood have been transitioning to adult outpatient health care service in Brazil since the late 2000's. Deterioration of clinical condition is expected during this period, as reported among youths with non-communicable chronic diseases. Despite their young age, they are long-term hosts of the virus, have prolonged exposure to antiretroviral therapy and have suffered from the social determinants and stigma of HIV infection since early childhood. Objectives This study aimed to 1) describe demographic and clinical characteristics at the first appointment at adult care service following pediatric care of a cohort of Brazilian youths living with HIV since childhood; and 2) retrospectively address adherence and clinical variables in the last two years of pediatric follow-up. Methods Descriptive study. Results 41 consecutive patients referred to adult outpatient care from a pediatric HIV unit were enrolled, median age 19 years, and median lifetime CD4 + nadir 117 cell/mm3; 89% reported previous AIDS-defining conditions. At first laboratory assessment in adult care, only 46% had undetectable (<400 copies/ml) HIV viral load and the median CD4 + count was 250 cell/mm3. Conclusion Youths living with HIV at the transition from pediatric to adult care had poor treatment adherence, low lifetime CD4 + cell nadir, low CD4 cell count and detectable HIV viral load. Health care providers should closely monitor these adolescents in a youth friendly environment, prepared for open communication about all aspects of their health.
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Abstract
PURPOSE OF REVIEW A total of 1.8 million adolescents live with HIV and constitute the only age group in which HIV-associated mortality continues to rise. Meeting their healthcare needs as they transition from paediatric services to adult care is vital for their own health and in prevention of onward transmission to partners and offspring. In this review, we discuss the issues around transition, both within HIV health care and the wider transitions adolescents negotiate as they move out of childhood and into adult life. RECENT FINDINGS Although transition models vary widely across the globe, the difficulties faced in gathering robust outcome data following transition to adult care and in linkage between paediatric and adult cohorts are universal. Data are particularly sparse for behaviourally infected adolescents outside North America and for key population groups. Poorer health outcomes universal to adolescents may reflect the complex multisystem developmental transition from childhood-to-adulthood, of which transition of healthcare services is a small part. SUMMARY The complex needs of this generation are well described and whilst examples of good practice are emerging, how best to support their transition to adulthood requires carefully tailored studies of cost-effective interventions that can be up scaled in resource limited settings.
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Madhombiro M, Cha R, Sawyer J, Przybyla S, Burstein G, Morse GD. Why do young adults living with HIV perform poorly on combined antiretroviral therapy (CART)? – a Zimbabwean perspective. Future Virol 2019. [DOI: 10.2217/fvl-2019-0020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Munyaradzi Madhombiro
- University of Zimbabwe, College of Health Sciences, Department of Psychiatry, Parirenyatwa Group of Health Sciences, Mazowe Street, Belgravia, Harare, Zimbabwe
| | - Raymond Cha
- University at Buffalo, The State University of New York, School of Pharmacy & Pharmaceutical Sciences, Buffalo, NY 14414, USA
| | - Joshua Sawyer
- University at Buffalo, The State University of New York, School of Pharmacy & Pharmaceutical Sciences, Buffalo, NY 14414, USA
| | - Sarahmona Przybyla
- University at Buffalo, The State University of New York, School of Public Health, Buffalo, NY 14214, USA
| | - Gale Burstein
- Commissioner of Health Erie County, Health 95 Franklin St, Room 910, Buffalo, NY 14202, USA
| | - Gene D Morse
- University at Buffalo, The State University of New York, Pharmacy Practice (Medicine, Pediatrics), SUNY Global Health Institute, UB Center for Integrated Global Biomedical Sciences, Drug Development Core, UB Clinical & Translational Science Institute, Translational Pharmacology Research Core, NYS Center of Excellence in Bioinformatics & Life Sciences, University at Buffalo, 701 Ellicott Street, Buffalo, NY 14203, 716-881-7464
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Enane LA, Vreeman RC, Foster C. Retention and adherence: global challenges for the long-term care of adolescents and young adults living with HIV. Curr Opin HIV AIDS 2019; 13:212-219. [PMID: 29570471 DOI: 10.1097/coh.0000000000000459] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW Adolescents living with HIV are the only age group with increasing HIV mortality at a time of global scale-up of access to antiretroviral therapy (ART). As a 'treat all' strategy is implemented worldwide, it is critically important to optimize retention and adherence for this vulnerable group. RECENT FINDINGS Adolescents and young adults living with HIV have poorer outcomes when compared with adults at each stage of the HIV care cascade, irrespective of income setting. Rates of viral suppression are lowest for adolescents living with HIV, and adherence to ART remains an enormous challenge. High-quality studies of interventions to improve linkage to, and retention in, care on suppressive ART are starkly lacking for adolescents and young adults living with HIV across the globe. However, examples of good practice are beginning to emerge but require large-scale implementation studies with outcome data disaggregated by age, route of infection, and income setting, and include young pregnant women and key populations groups. SUMMARY There is an urgent need for evidence-based interventions addressing gaps in the adolescent HIV care cascade, including supporting retention in care and adherence to ART.
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Affiliation(s)
- Leslie A Enane
- Department of Pediatrics, The Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Academic Model Providing Access to Healthcare (AMPATH)
| | - Rachel C Vreeman
- Department of Pediatrics, The Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, Indiana, USA.,Academic Model Providing Access to Healthcare (AMPATH).,Department of Child Health and Pediatrics, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Caroline Foster
- Departments of GUM/HIV and Pediatrics, Imperial College Healthcare NHS Trust, London, United Kingdom
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The global epidemiology of adolescents living with HIV: time for more granular data to improve adolescent health outcomes. Curr Opin HIV AIDS 2019; 13:170-178. [PMID: 29432227 DOI: 10.1097/coh.0000000000000449] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The aim of this study was to summarize recent evidence on the global epidemiology of adolescents (age 10-19 years) living with HIV (ALHIV), the burden of HIV on the health of adolescents and HIV-associated mortality. RECENT FINDINGS In 2016, there were an estimated 2.1 million (uncertainty bound 1.4-2.7 million) ALHIV; 770 000 younger (age 10-14 years) and 1.03 million older (age 15-19 years) ALHIV, 84% living in sub-Saharan Africa. The population of ALHIV is increasing, as more peri/postnatally infected ALHIV survive into older ages; an estimated 35% of older female ALHIV were peri/postnatally infected, compared with 57% of older male ALHIV. Although the numbers of younger ALHIV deaths are declining, deaths among older ALHIV have remained static since peaking in 2012. In 2015, HIV-associated mortality was the eighth leading cause of adolescent death globally and the fourth leading cause in African low and middle-income countries. SUMMARY Needed investments into characterizing and improving adolescent HIV-related health outcomes include strengthening systems for nationally and globally disaggregated data by age, sex and mode of infection; collecting more granular data within routine programmes to identify structural, social and mental health challenges to accessing testing and care; and prioritizing viral load monitoring and adolescent-focused differentiated models of care.
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Rojas Sánchez P, Cobos A, Navaro M, Ramos JT, Pagán I, Holguín Á. Impact of Clinical Parameters in the Intrahost Evolution of HIV-1 Subtype B in Pediatric Patients: A Machine Learning Approach. Genome Biol Evol 2018; 9:2715-2726. [PMID: 29044435 PMCID: PMC5647794 DOI: 10.1093/gbe/evx193] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2017] [Indexed: 12/24/2022] Open
Abstract
Determining the factors modulating the genetic diversity of HIV-1 populations is essential to understand viral evolution. This study analyzes the relative importance of clinical factors in the intrahost HIV-1 subtype B (HIV-1B) evolution and in the fixation of drug resistance mutations (DRM) during longitudinal pediatric HIV-1 infection. We recovered 162 partial HIV-1B pol sequences (from 3 to 24 per patient) from 24 perinatally infected patients from the Madrid Cohort of HIV-1 infected children and adolescents in a time interval ranging from 2.2 to 20.3 years. We applied machine learning classification methods to analyze the relative importance of 28 clinical/epidemiological/virological factors in the HIV-1B evolution to predict HIV-1B genetic diversity (d), nonsynonymous and synonymous mutations (dN, dS) and DRM presence. Most of the 24 HIV-1B infected pediatric patients were Spanish (91.7%), diagnosed before 2000 (83.3%), and all were antiretroviral therapy experienced. They had from 0.3 to 18.8 years of HIV-1 exposure at sampling time. Most sequences presented DRM. The best-predictor variables for HIV-1B evolutionary parameters were the age of HIV-1 diagnosis for d, the age at first antiretroviral treatment for dN and the year of HIV-1 diagnosis for ds. The year of infection (birth year) and year of sampling seemed to be relevant for fixation of both DRM at large and, considering drug families, to protease inhibitors (PI). This study identifies, for the first time using machine learning, the factors affecting more HIV-1B pol evolution and those affecting DRM fixation in HIV-1B infected pediatric patients.
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Affiliation(s)
- Patricia Rojas Sánchez
- HIV-1 Molecular Epidemiology Laboratory, Department of Microbiology, Hospital Ramón y Cajal-IRYCIS and CIBER-ESP (Madrid Cohort of HIV-1 Infected Children and Adolescents Integrated in the Pediatric Branch of the Spanish National AIDS Network (CoRISPe), Madrid, Spain.,Transcription-associated genome instability Laboratory, Institute of Cancer and Genomic Sciences, School of Medicine, University of Birmingham, Birmingham, United Kingdom
| | - Alberto Cobos
- Department of Plant-Microbe Interaction, Centro de Biotecnología y Genómica de Plantas (UPM-INIA) and E.T.S.I. Agrónomos, Universidad Politécnica de Madrid, Spain
| | - Marisa Navaro
- Department of Infectious Diseases, Hospital General Universitario Gregorio Marañón-CORISPe, Madrid, Spain
| | - José Tomas Ramos
- Department of Infectious Diseases, Hospital Clínico Universitario and Universidad Complutense-CORISPe, Madrid, Spain
| | - Israel Pagán
- Department of Plant-Microbe Interaction, Centro de Biotecnología y Genómica de Plantas (UPM-INIA) and E.T.S.I. Agrónomos, Universidad Politécnica de Madrid, Spain
| | - África Holguín
- HIV-1 Molecular Epidemiology Laboratory, Department of Microbiology, Hospital Ramón y Cajal-IRYCIS and CIBER-ESP (Madrid Cohort of HIV-1 Infected Children and Adolescents Integrated in the Pediatric Branch of the Spanish National AIDS Network (CoRISPe), Madrid, Spain
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Slogrove AL, Schomaker M, Davies MA, Williams P, Balkan S, Ben-Farhat J, Calles N, Chokephaibulkit K, Duff C, Eboua TF, Kekitiinwa-Rukyalekere A, Maxwell N, Pinto J, Seage G, Teasdale CA, Wanless S, Warszawski J, Wools-Kaloustian K, Yotebieng M, Timmerman V, Collins IJ, Goodall R, Smith C, Patel K, Paul M, Gibb D, Vreeman R, Abrams EJ, Hazra R, Van Dyke R, Bekker LG, Mofenson L, Vicari M, Essajee S, Penazzato M, Anabwani G, Q. Mohapi E, N. Kazembe P, Hlatshwayo M, Lumumba M, Goetghebuer T, Thorne C, Galli L, van Rossum A, Giaquinto C, Marczynska M, Marques L, Prata F, Ene L, Okhonskaia L, Rojo P, Fortuny C, Naver L, Rudin C, Le Coeur S, Volokha A, Rouzier V, Succi R, Sohn A, Kariminia A, Edmonds A, Lelo P, Ayaya S, Ongwen P, Jefferys LF, Phiri S, Mubiana-Mbewe M, Sawry S, Renner L, Sylla M, Abzug MJ, Levin M, Oleske J, Chernoff M, Traite S, Purswani M, Chadwick EG, Judd A, Leroy V. The epidemiology of adolescents living with perinatally acquired HIV: A cross-region global cohort analysis. PLoS Med 2018; 15:e1002514. [PMID: 29494593 PMCID: PMC5832192 DOI: 10.1371/journal.pmed.1002514] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 01/24/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Globally, the population of adolescents living with perinatally acquired HIV (APHs) continues to expand. In this study, we pooled data from observational pediatric HIV cohorts and cohort networks, allowing comparisons of adolescents with perinatally acquired HIV in "real-life" settings across multiple regions. We describe the geographic and temporal characteristics and mortality outcomes of APHs across multiple regions, including South America and the Caribbean, North America, Europe, sub-Saharan Africa, and South and Southeast Asia. METHODS AND FINDINGS Through the Collaborative Initiative for Paediatric HIV Education and Research (CIPHER), individual retrospective longitudinal data from 12 cohort networks were pooled. All children infected with HIV who entered care before age 10 years, were not known to have horizontally acquired HIV, and were followed up beyond age 10 years were included in this analysis conducted from May 2016 to January 2017. Our primary analysis describes patient and treatment characteristics of APHs at key time points, including first HIV-associated clinic visit, antiretroviral therapy (ART) start, age 10 years, and last visit, and compares these characteristics by geographic region, country income group (CIG), and birth period. Our secondary analysis describes mortality, transfer out, and lost to follow-up (LTFU) as outcomes at age 15 years, using competing risk analysis. Among the 38,187 APHs included, 51% were female, 79% were from sub-Saharan Africa and 65% lived in low-income countries. APHs from 51 countries were included (Europe: 14 countries and 3,054 APHs; North America: 1 country and 1,032 APHs; South America and the Caribbean: 4 countries and 903 APHs; South and Southeast Asia: 7 countries and 2,902 APHs; sub-Saharan Africa, 25 countries and 30,296 APHs). Observation started as early as 1982 in Europe and 1996 in sub-Saharan Africa, and continued until at least 2014 in all regions. The median (interquartile range [IQR]) duration of adolescent follow-up was 3.1 (1.5-5.2) years for the total cohort and 6.4 (3.6-8.0) years in Europe, 3.7 (2.0-5.4) years in North America, 2.5 (1.2-4.4) years in South and Southeast Asia, 5.0 (2.7-7.5) years in South America and the Caribbean, and 2.1 (0.9-3.8) years in sub-Saharan Africa. Median (IQR) age at first visit differed substantially by region, ranging from 0.7 (0.3-2.1) years in North America to 7.1 (5.3-8.6) years in sub-Saharan Africa. The median age at ART start varied from 0.9 (0.4-2.6) years in North America to 7.9 (6.0-9.3) years in sub-Saharan Africa. The cumulative incidence estimates (95% confidence interval [CI]) at age 15 years for mortality, transfers out, and LTFU for all APHs were 2.6% (2.4%-2.8%), 15.6% (15.1%-16.0%), and 11.3% (10.9%-11.8%), respectively. Mortality was lowest in Europe (0.8% [0.5%-1.1%]) and highest in South America and the Caribbean (4.4% [3.1%-6.1%]). However, LTFU was lowest in South America and the Caribbean (4.8% [3.4%-6.7%]) and highest in sub-Saharan Africa (13.2% [12.6%-13.7%]). Study limitations include the high LTFU rate in sub-Saharan Africa, which could have affected the comparison of mortality across regions; inclusion of data only for APHs receiving ART from some countries; and unavailability of data from high-burden countries such as Nigeria. CONCLUSION To our knowledge, our study represents the largest multiregional epidemiological analysis of APHs. Despite probable under-ascertained mortality, mortality in APHs remains substantially higher in sub-Saharan Africa, South and Southeast Asia, and South America and the Caribbean than in Europe. Collaborations such as CIPHER enable us to monitor current global temporal trends in outcomes over time to inform appropriate policy responses.
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Affiliation(s)
| | - Amy L. Slogrove
- Center for Infectious Diseases Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Michael Schomaker
- Center for Infectious Diseases Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Mary-Ann Davies
- Center for Infectious Diseases Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Paige Williams
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Suna Balkan
- Epicentre, Médecins Sans Frontières, Paris, France
| | | | - Nancy Calles
- Baylor International Pediatric AIDS Initiative, Texas Children’s Hospital-USA, Houston, Texas, United States of America
| | | | - Charlotte Duff
- MRC Clinical Trials Unit at University College London, London, United Kingdom
| | - Tanoh François Eboua
- Yopougon University Hospital, University Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire
| | | | - Nicola Maxwell
- Center for Infectious Diseases Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Jorge Pinto
- School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - George Seage
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Chloe A. Teasdale
- ICAP at Columbia University Mailman School of Public Health, New York, New York, United States of America
| | - Sebastian Wanless
- Baylor International Pediatric AIDS Initiative, Texas Children’s Hospital-USA, Houston, Texas, United States of America
| | - Josiane Warszawski
- Inserm (French Institute of Health and Medical Research), CESP UMR Villejuif, France
| | - Kara Wools-Kaloustian
- Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Marcel Yotebieng
- College of Public Health, Ohio State University, Columbus, Ohio, United States of America
| | - Venessa Timmerman
- Center for Infectious Diseases Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Intira J. Collins
- MRC Clinical Trials Unit at University College London, London, United Kingdom
| | - Ruth Goodall
- MRC Clinical Trials Unit at University College London, London, United Kingdom
| | - Colette Smith
- MRC Clinical Trials Unit at University College London, London, United Kingdom
| | - Kunjal Patel
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Mary Paul
- Baylor International Pediatric AIDS Initiative, Texas Children’s Hospital-USA, Houston, Texas, United States of America
| | - Diana Gibb
- MRC Clinical Trials Unit at University College London, London, United Kingdom
| | - Rachel Vreeman
- Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Elaine J. Abrams
- ICAP at Columbia University Mailman School of Public Health, New York, New York, United States of America
| | - Rohan Hazra
- National Institute of Child Health and Human Development (NICHD), US National Institutes of Health, Rockville, Maryland, United States of America
| | - Russell Van Dyke
- Tulane University, New Orleans, Louisiana, United States of America
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Lynne Mofenson
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, United States of America
| | | | | | | | - Gabriel Anabwani
- Baylor International Pediatric AIDS Initiative, Gaborone, Botswana
| | - Edith Q. Mohapi
- Baylor International Pediatric AIDS Initiative, Maseru, Lesotho
| | - Peter N. Kazembe
- Baylor International Pediatric AIDS Initiative, Lilongwe, Malawi
| | | | - Mwita Lumumba
- Baylor International Pediatric AIDS Initiative, Mbeya, Tanzania
| | | | - Claire Thorne
- Institute of Child Health, University College London, London, United Kingdom
| | - Luisa Galli
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Annemarie van Rossum
- Erasmus MC University Medical Center Rotterdam-Sophia Children’s Hospital, Rotterdam, the Netherlands
| | | | - Magdalena Marczynska
- Medical University of Warsaw, Hospital of Infectious Diseases in Warsaw, Warsaw, Poland
| | | | | | | | - Liubov Okhonskaia
- Republican Hospital of Infectious Diseases, St Petersburg, Russian Federation
| | | | - Claudia Fortuny
- Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Lars Naver
- Karolinska University Hospital, Stockholm, Sweden
| | | | - Sophie Le Coeur
- Institut de Recherche pour le Développement (IRD) 174/PHPT, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
- Institut National d'Etudes Démograhiques (Ined), F-75020 Paris, France
| | - Alla Volokha
- Shupyk National Medical Academy of Postgraduate Education, Kiev, Ukraine
| | | | - Regina Succi
- Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | - Andrew Edmonds
- Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Patricia Lelo
- Pediatric Hospital Kalembe Lembe, Lingwala, Kinshasa, Democratic Republic of Congo
| | - Samuel Ayaya
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Patricia Ongwen
- Family AIDS Care and Education Services, Kenya Medical Research Institute, Kisumu, Kenya
| | | | - Sam Phiri
- Lighthouse Trust Clinic, Lilongwe, Malawi
| | | | - Shobna Sawry
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Harriet Shezi Children’s Clinic, Chris Hani Baragwanath Hospital, Johannesburg, South Africa
| | - Lorna Renner
- University of Ghana School of Medicine and Dentistry, Accra, Ghana
| | | | - Mark J. Abzug
- University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado, United States of America
| | - Myron Levin
- University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado, United States of America
| | - James Oleske
- Rutgers New Jersey Medical School, Newark, New Jersey, United States of America
| | - Miriam Chernoff
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Shirley Traite
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Murli Purswani
- Bronx-Lebanon Hospital Center (Icahn School of Medicine at Mount Sinai), Bronx, New York, United States of America
| | - Ellen G. Chadwick
- Feinberg School of Medicine, Northwestern University, Evanston, Illinois, United States of America
| | - Ali Judd
- MRC Clinical Trials Unit at University College London, London, United Kingdom
- * E-mail: (AJ); (VL)
| | - Valériane Leroy
- Inserm (French Institute of Health and Medical Research), UMR 1027 Université Toulouse 3, Toulouse, France
- * E-mail: (AJ); (VL)
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Jao J, Kacanek D, Williams PL, Geffner ME, Livingston EG, Sperling RS, Patel K, Bardeguez AD, Burchett SK, Chakhtoura N, Scott GB, Van Dyke RB, Abrams EJ. Birth Weight and Preterm Delivery Outcomes of Perinatally vs Nonperinatally Human Immunodeficiency Virus-Infected Pregnant Women in the United States: Results From the PHACS SMARTT Study and IMPAACT P1025 Protocol. Clin Infect Dis 2018; 65:982-989. [PMID: 28575201 DOI: 10.1093/cid/cix488] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 05/23/2017] [Indexed: 12/16/2022] Open
Abstract
Background Pregnancy outcomes of perinatally human immunodeficiency virus-infected women (PHIV) are poorly defined. Methods We compared preterm delivery and birth weight (BW) outcomes (low BW [LBW], <2500 g), small-for-gestational-age [SGA], and BW z scores [BWZ]) in HIV-exposed uninfected infants of PHIV vs nonperinatally HIV-infected (NPHIV) pregnant women in the Pediatric HIV/AIDS Cohort Study Surveillance Monitoring of ART Toxicities or International Maternal Pediatric Adolescent AIDS Clinical Trials P1025 studies. Mixed effects models and log binomial models were used to assess the association of maternal PHIV status with infant outcomes. Age-stratified analyses were performed. Results From 1998 to 2013, 2270 HIV-infected pregnant women delivered 2692 newborns (270 born to PHIV and 2422 to NPHIV women). PHIV women were younger, (mean age 21 vs 25 years, P < .01) and more likely to have a pregnancy CD4 count <200 cells/mm3 (19% vs 11%, P = .01). No associations between maternal PHIV status and preterm delivery, SGA, or LBW were observed. After adjustment, BWZ was 0.12 lower in infants of PHIV vs NPHIV women (adjusted mean, -0.45 vs -0.33; P = .04). Among women aged 23-30 years (n = 1770), maternal PHIV was associated with LBW (aRR = 1.74; 95% confidence interval, 1.18, 2.58; P < .01). Conclusion The overall lack of association between maternal PHIV status and preterm delivery or infant BW outcomes is reassuring. The higher rates of LBW observed in PHIV women aged 23-30 years warrants further mechanism-based investigations as this is a rapidly growing and aging population worldwide. Clinical Trials Registration PHACS SMARTT study, NCT01310023. Clinical Trials Registration IMPAACT 1025, NCT00028145.
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Affiliation(s)
- Jennifer Jao
- Departments of Medicine and Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Deborah Kacanek
- Department of Biostatistics, Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Paige L Williams
- Department of Biostatistics, Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Mitchell E Geffner
- Saban Research Institute of Children's Hospital Los Angeles, Keck School of Medicine of the University of Southern California
| | - Elizabeth G Livingston
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
| | - Rhoda S Sperling
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kunjal Patel
- Department of Epidemiology, Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Arlene D Bardeguez
- Department of Obstetrics, Gynecology, and Women's Health, Rutgers New Jersey Medical School, Newark
| | - Sandra K Burchett
- Division of Infectious Diseases, Boston Children's Hospital and Harvard Medical School, Massachusetts
| | - Nahida Chakhtoura
- Maternal and Pediatric Infectious Disease Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Gwendolyn B Scott
- Department of Pediatrics, Division of Pediatric Infectious Disease and Immunology, University of Miami Miller School of Medicine, Florida
| | - Russell B Van Dyke
- Department of Pediatrics, Section of Infectious Diseases, Tulane University School of Medicine, New Orleans, Louisiana
| | - Elaine J Abrams
- Mailman School of Public Health and College of Physicians & Surgeons, International Center for AIDS Care and Treatment Program, Columbia University, New York, New York
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Time to Switch to Second-line Antiretroviral Therapy in Children With Human Immunodeficiency Virus in Europe and Thailand. Clin Infect Dis 2018; 66:594-603. [PMID: 29029056 PMCID: PMC5796645 DOI: 10.1093/cid/cix854] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 09/20/2017] [Indexed: 01/17/2023] Open
Abstract
Background Data on durability of first-line antiretroviral therapy (ART) in children with human immunodeficiency virus (HIV) are limited. We assessed time to switch to second-line therapy in 16 European countries and Thailand. Methods Children aged <18 years initiating combination ART (≥2 nucleoside reverse transcriptase inhibitors [NRTIs] plus nonnucleoside reverse transcriptase inhibitor [NNRTI] or boosted protease inhibitor [PI]) were included. Switch to second-line was defined as (i) change across drug class (PI to NNRTI or vice versa) or within PI class plus change of ≥1 NRTI; (ii) change from single to dual PI; or (iii) addition of a new drug class. Cumulative incidence of switch was calculated with death and loss to follow-up as competing risks. Results Of 3668 children included, median age at ART initiation was 6.1 (interquartile range (IQR), 1.7-10.5) years. Initial regimens were 32% PI based, 34% nevirapine (NVP) based, and 33% efavirenz based. Median duration of follow-up was 5.4 (IQR, 2.9-8.3) years. Cumulative incidence of switch at 5 years was 21% (95% confidence interval, 20%-23%), with significant regional variations. Median time to switch was 30 (IQR, 16-58) months; two-thirds of switches were related to treatment failure. In multivariable analysis, older age, severe immunosuppression and higher viral load (VL) at ART start, and NVP-based initial regimens were associated with increased risk of switch. Conclusions One in 5 children switched to a second-line regimen by 5 years of ART, with two-thirds failure related. Advanced HIV, older age, and NVP-based regimens were associated with increased risk of switch.
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Judd A, Chappell E, Turkova A, Le Coeur S, Noguera-Julian A, Goetghebuer T, Doerholt K, Galli L, Pajkrt D, Marques L, Collins IJ, Gibb DM, González Tome MI, Navarro M, Warszawski J, Königs C, Spoulou V, Prata F, Chiappini E, Naver L, Giaquinto C, Thorne C, Marczynska M, Okhonskaia L, Posfay-Barbe K, Ounchanum P, Techakunakorn P, Kiseleva G, Malyuta R, Volokha A, Ene L, Goodall R. Long-term trends in mortality and AIDS-defining events after combination ART initiation among children and adolescents with perinatal HIV infection in 17 middle- and high-income countries in Europe and Thailand: A cohort study. PLoS Med 2018; 15:e1002491. [PMID: 29381702 PMCID: PMC5790238 DOI: 10.1371/journal.pmed.1002491] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 12/13/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Published estimates of mortality and progression to AIDS as children with HIV approach adulthood are limited. We describe rates and risk factors for death and AIDS-defining events in children and adolescents after initiation of combination antiretroviral therapy (cART) in 17 middle- and high-income countries, including some in Western and Central Europe (W&CE), Eastern Europe (Russia and Ukraine), and Thailand. METHODS AND FINDINGS Children with perinatal HIV aged <18 years initiating cART were followed until their 21st birthday, transfer to adult care, death, loss to follow-up, or last visit up until 31 December 2013. Rates of death and first AIDS-defining events were calculated. Baseline and time-updated risk factors for early/late (≤/>6 months of cART) death and progression to AIDS were assessed. Of 3,526 children included, 32% were from the United Kingdom or Ireland, 30% from elsewhere in W&CE, 18% from Russia or Ukraine, and 20% from Thailand. At cART initiation, median age was 5.2 (IQR 1.4-9.3) years; 35% of children aged <5 years had a CD4 lymphocyte percentage <15% in 1997-2003, which fell to 15% of children in 2011 onwards (p < 0.001). Similarly, 53% and 18% of children ≥5 years had a CD4 count <200 cells/mm3 in 1997-2003 and in 2011 onwards, respectively (p < 0.001). Median follow-up was 5.6 (2.9-8.7) years. Of 94 deaths and 237 first AIDS-defining events, 43 (46%) and 100 (42%) were within 6 months of initiating cART, respectively. Multivariable predictors of early death were: being in the first year of life; residence in Russia, Ukraine, or Thailand; AIDS at cART start; initiating cART on a nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimen; severe immune suppression; and low BMI-for-age z-score. Current severe immune suppression, low current BMI-for-age z-score, and current viral load >400 c/mL predicted late death. Predictors of early and late progression to AIDS were similar. Study limitations include incomplete recording of US Centers for Disease Control (CDC) disease stage B events and serious adverse events in some countries; events that were distributed over a long time period, and that we lacked power to analyse trends in patterns and causes of death over time. CONCLUSIONS In our study, 3,526 children and adolescents with perinatal HIV infection initiated antiretroviral therapy (ART) in countries in Europe and Thailand. We observed that over 40% of deaths occurred ≤6 months after cART initiation. Greater early mortality risk in infants, as compared to older children, and in Russia, Ukraine, or Thailand as compared to W&CE, raises concern. Current severe immune suppression, being underweight, and unsuppressed viral load were associated with a higher risk of death at >6 months after initiation of cART.
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Affiliation(s)
| | - Ali Judd
- MRC Clinical Trials Unit, University College London (UCL), London, United Kingdom
- * E-mail:
| | - Elizabeth Chappell
- MRC Clinical Trials Unit, University College London (UCL), London, United Kingdom
| | - Anna Turkova
- MRC Clinical Trials Unit, University College London (UCL), London, United Kingdom
| | - Sophie Le Coeur
- Institut National d'Etude Demographique (INED), Mortality, Health and Epidemiology Unit, Paris, France
- Institut de Recherche pour le Developpement (IRD), UMI 174/PHPT, Chiang Mai, Thailand
| | - Antoni Noguera-Julian
- Unitat d’Infectologia, Servei de Pediatria, Hospital Sant Joan de Deu, Universitat de Barcelona, Barcelona, Spain
| | | | - Katja Doerholt
- St George’s Healthcare NHS Trust, London, United Kingdom
| | - Luisa Galli
- Department of Health Sciences, Pediatric Unit, University of Florence, Florence, Italy
| | - Dasja Pajkrt
- Department of Pediatric Infectious Diseases, Emma Children’s Hospital, Academic Medical Center, Amsterdam, the Netherlands
| | | | - Intira J. Collins
- MRC Clinical Trials Unit, University College London (UCL), London, United Kingdom
| | - Diana M. Gibb
- MRC Clinical Trials Unit, University College London (UCL), London, United Kingdom
| | | | - Marisa Navarro
- Hospital General Universitario "Gregorio Marañón", Madrid, Spain
| | - Josiane Warszawski
- Institut National de la Santé et de la Recherche (INSERM), Paris, France
| | - Christoph Königs
- University Hospital Frankfurt, Department of Paediatrics, Goethe University, Frankfurt, Germany
| | - Vana Spoulou
- University of Athens Medical School, Athens, Greece
| | | | - Elena Chiappini
- Department of Health Sciences, Pediatric Unit, University of Florence, Florence, Italy
| | - Lars Naver
- Karolinska University Hospital, Stockholm, Sweden
| | - Carlo Giaquinto
- Paediatric European Network for the Treatment of AIDS (PENTA), Padova, Italy
| | - Claire Thorne
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | | | | | | | | | | | - Galina Kiseleva
- Shupyk National Medical Academy of Postgraduate Education, Kiev, Ukraine
| | - Ruslan Malyuta
- Perinatal Prevention of AIDS Initiative, Odessa, Ukraine
| | - Alla Volokha
- Shupyk National Medical Academy of Postgraduate Education, Kiev, Ukraine
| | | | - Ruth Goodall
- MRC Clinical Trials Unit, University College London (UCL), London, United Kingdom
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Meeting the WHO 90% target: antiretroviral treatment efficacy in Poland is associated with baseline clinical patient characteristics. J Int AIDS Soc 2017; 20:21847. [PMID: 28715160 PMCID: PMC5577695 DOI: 10.7448/ias.20.1.21847] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Introduction: Modern combined antiretroviral therapies (cART) allow to effectively suppress HIV-1 viral load, with the 90% virologic success rate, meeting the WHO target in most clinical settings. The aim of this study was to analyse antiretroviral treatment efficacy in Poland and to identify variables associated with virologic suppression. Methods: Cross-sectional data on 5152 (56.92% of the countrywide treated at the time-point of analysis) patients on cART for more than six months with at least one HIV-RNA measurement in 2016 were collected from 14 Polish centres. Patients’ characteristics and treatment type-based outcomes were analysed for the virologic suppression thresholds of <50 and <200 HIV-RNA copies/ml. CART was categorized into two nucleos(t)ide (2NRTI) plus non-nucleoside reverse transcriptase (NNRTI) inhibitors, 2NRTI plus protease (PI) inhibitor, 2NRTI plus integrase (InI) inhibitor, nucleos(t)ide sparing PI/r+InI and three drug class regimens. For statistics Chi-square and U-Mann Whitney tests and adjusted multivariate logistic regression models were used. Results: Virologic suppression rates of <50 copies/mL were observed in 4672 (90.68%) and <200 copies/mL in 4934 (95.77%) individuals. In univariate analyses, for the suppression threshold <50 copies/mL higher efficacy was noted for 2NRTI+NNRTI-based combinations (94.73%) compared to 2NRTI+PI (89.93%), 2NRTI+InI (90.61%), nucleos(t)ide sparing PI/r+InI (82.02%) and three drug class regimens (74.49%) (p < 0.0001), with less pronounced but significant differences for the threshold of 200 copies/mL [2NRTI+NNRTI-97.61%, 2NRTI+PI-95.27%, 2NRTI+InI-96.61%, PI/r+InI- 95.51% and 86.22% for three drug class cART) (p < 0.0001). However, in multivariate model, virologic efficacy for viral load <50 copies/mL was similar across treatment groups with significant influence by history of AIDS [OR:1.48 (95%CI:1.01–2.17) if AIDS diagnosed, p = 0.046], viral load < 5 log copies/mL at care entry [OR:1.47 (95%CI:1.08–2.01), p = 0.016], baseline lymphocyte CD4 count ≥200 cells/µL [OR:1.72 (95%CI:1.04–2.78), p = 0.034] and negative HCV serology [OR:1.97 (95%CI:1.29–2.94), p = 0.002]. For viral load threshold <200 copies/mL higher likelihood of virologic success was only associated with baseline lymphocyte CD4 count ≥200 cells/µL [OR:2.08 (95%CI:1.01–4.35), p = 0.049] and negative HCV status [OR:2.84 (95%CI:1.52–5.26), p = 0.001]. Conclusions: Proportion of virologically suppressed patients is in line with WHO treatment target confirming successful application of antiretroviral treatment strategy in Poland. Virological suppression rates depend on baseline patient characteristics, which should guide individualized antiretroviral tre0atment decisions.
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A review of transition experiences in perinatally and behaviourally acquired HIV-1 infection; same, same but different? J Int AIDS Soc 2017; 20:21506. [PMID: 28530044 PMCID: PMC5577725 DOI: 10.7448/ias.20.4.21506] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Introduction: Despite sharing common psychosocial and developmental experiences, adolescents living with perinatally and behaviourally acquired HIV-1 infection are different in terms of timing of HIV infection and developmental stage at infection. Therefore, it is of interest to identify similarities and differences between these two groups of adolescents living with HIV in their experiences, facilitators and barriers during the transition process. Methods: A detailed literature search of peer-reviewed published papers was conducted on PubMed to identify relevant original research or viewpoints published up to September 2016. Conference abstracts and other unpublished data sources were not included. Results: Existing published literature, mainly using qualitative methods, explores the transition from paediatric to adult healthcare provision, as experienced by these two groups of young people. Reports highlight the variation and similarities in their experiences and challenges of transition. Findings from the USA and Europe predominate, while experience from Africa and Asia is lacking, despite the importance of these regions in the global epidemic. Conclusions: Published transition data remain limited, and there are few studies focusing on behaviourally infected adolescents and key population groups (e.g. adolescents who use drugs, lesbian/gay/transgender individuals). Robust definitions of the transition process and standardized outcome measures are required to facilitate cross-study and geographic comparisons.
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Living and dying to be counted: What we know about the epidemiology of the global adolescent HIV epidemic. J Int AIDS Soc 2017; 20:21520. [PMID: 28530036 PMCID: PMC5719718 DOI: 10.7448/ias.20.4.21520] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Introduction: With increasing survival of vertically HIV‐infected children and ongoing new horizontal HIV infections, the population of adolescents (age 10–19 years) living with HIV is increasing. This review aims to describe the epidemiology of the adolescent HIV epidemic and the ability of national monitoring systems to measure outcomes in HIV‐infected adolescents through the adolescent transition to adulthood. Methods: Differences in global trends between younger (age 10–14 years) and older (age 15–19 years) adolescents in key epidemic indicators are interrogated using 2016 UNAIDS estimates. National population‐based survey data in the 15 highest adolescent HIV burden countries are evaluated and examples of national case‐based surveillance systems described. Finally, we consider the potential impact of adolescent‐specific recommendations in the 2016 WHO Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection. Discussion: UNAIDS estimates indicate the population of adolescents living with HIV is increasing, new HIV infections in older adolescents are declining, and while AIDS‐related deaths are beginning to decline in younger adolescents, they are still increasing in older adolescents. National population‐based surveys provide valuable estimates of HIV prevalence in older adolescents and recent surveys include data on younger adolescents. Only a few countries have nationwide electronic case‐based HIV surveillance, with the ability to provide population‐level data on key HIV outcomes in the diagnosed population living with HIV. However, in the 15 highest adolescent HIV burden countries, there are no systems tracking adolescent transition to adulthood or healthcare transition. The strength of the 2016 WHO adolescent‐specific recommendations on antiretroviral therapy and provision of HIV services to adolescents was hampered by the lack of evidence specific to this age group. Conclusions: Progress is being made in national surveillance and global monitoring systems to specifically identify trends in adolescents living with HIV. However, HIV programmes responsive to the evolving HIV prevention and treatment needs of adolescents can be facilitated further by: data disaggregation to younger and older adolescents and mode of HIV infection where feasible; implementation of tools to achieve expanded national case‐based surveillance; streamlining consent/assent procedures in younger adolescents and consensus on indicators of adolescent healthcare transition and transition to adulthood.
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Judd A, Collins IJ, Parrott F, Hill T, Jose S, Ford D, Asad H, Gibb DM, Sabin C. Growing up with perinatal HIV: changes in clinical outcomes before and after transfer to adult care in the UK. J Int AIDS Soc 2017; 20:21577. [PMID: 28530042 PMCID: PMC5577702 DOI: 10.7448/ias.20.4.21577] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 02/14/2017] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION With improved survival, adolescents with perinatal HIV (PHIV) are transitioning from paediatric to adult care, but there are few published data on clinical outcomes post-transfer. Using linked data from patients in the national UK/Ireland paediatric cohort (CHIPS) and an adult UK cohort of outpatient clinics (UK CHIC), we describe mortality and changes in immunological status post-transfer. METHODS Participants in CHIPS aged ≥13 years by the end of 2013 were linked to the UK CHIC database. Mixed effects models explored changes in CD4 count before and after transfer, including interactions between time and variables where interaction p < 0.05. RESULTS Of 1,215 paediatric participants aged ≥13 years, 271 (22%) had linked data in UK CHIC. One hundred and forty-six (53%) were female, median age at last visit in paediatric care was 17 [interquartile range, IQR 16,18] years, median duration in paediatric care was 11.8 [6.6,15.5] years, and in adult care was 2.9 [1.5,5.9] years. At last visit in paediatric care, 74% (n = 200) were on ART, increasing to 84% (n = 228, p = 0.001) at last visit in adult care. In the 12 months before leaving paediatric care, 92 (47%) had two consecutive viral loads >400 copies/mL or one viral load >10,000 copies/mL, and likewise 102 (52%) in the 12 months post-transfer (p = 0.79). Seven (3%) people died in adult care. In multivariable analysis, CD4 declined as patients approached transition with a greater decline in those with higher nadir CD4 count (mean rates of decline of 3, 13, 15, 30 cells/mm3 per year for those with nadir CD4 < 100, 100-199, 200-299 and ≥300 cells/mm3, respectively). Post-transition, CD4 continued to decline in some groups (e.g. black males, -20 (-34, -5) cells/mm3 per year post transition, p = 0.007)) while it improved in others. Overall CD4 was higher with later year of birth (14 (7, 21) cells/mm3 per later year). There was no effect of age at transfer or changing hospital at transfer on CD4. CONCLUSIONS Our findings suggest that CD4 in adolescents with perinatal HIV in the UK was declining in the period before transition to adult care, and there was some reversal in this trend post-transfer in some groups. Across the transition period, CD4 was higher in those with later birth years, suggesting improvements in clinical care and/or transition planning over time.
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Affiliation(s)
- Ali Judd
- MRC Clinical Trials Unit, University College London (UCL), UCL, London, UK
| | | | - Francesca Parrott
- MRC Clinical Trials Unit, University College London (UCL), UCL, London, UK
| | - Teresa Hill
- MRC Clinical Trials Unit, University College London (UCL), UCL, London, UK
- Research Department of Infection and Population Health, UCL, London, UK
| | - Sophie Jose
- Research Department of Infection and Population Health, UCL, London, UK
| | - Deborah Ford
- MRC Clinical Trials Unit, University College London (UCL), UCL, London, UK
| | - Hibo Asad
- MRC Clinical Trials Unit, University College London (UCL), UCL, London, UK
| | - Diana M. Gibb
- MRC Clinical Trials Unit, University College London (UCL), UCL, London, UK
| | - Caroline Sabin
- Research Department of Infection and Population Health, UCL, London, UK
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