Adam W Bartlett1, Thahira Jamal Mohamed2, Tavitiya Sudjaritruk3, Nia Kurniati4, Revathy Nallusamy5, Rawiwan Hansudewechakul6, Penh Sun Ly7, Khanh Huu Truong8, Pagakrong Lumbiganon9, Thanyawee Puthanakit10, Kulkanya Chokephaibulkit11, Lam Van Nguyen12, Viet Chau Do13, Nagalingeswaran Kumarasamy14, Nik Khairulddin Nik Yusoff15, Moy Siew Fong16, Dewi Kumara Wati17, Annette H Sohn18, Azar Kariminia1. 1. From the The Kirby Institute, UNSW, Sydney, Australia. 2. Pediatric Institute, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia. 3. Department of Pediatrics, Faculty of Medicine, and Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand. 4. Cipto Mangunkusumo - Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia. 5. Penang Hospital, Penang, Malaysia. 6. Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand. 7. National Centre for HIV/AIDS, Dermatology and STDs, Phnom Penh, Cambodia. 8. Children's Hospital 1, Ho Chi Minh City, Vietnam. 9. Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. 10. Department of Pediatrics, Faculty of Medicine and Research Unit in Pediatric and Infectious Diseases, Chulalongkorn University. 11. Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. 12. National Hospital of Pediatrics, Hanoi, Vietnam. 13. Children's Hospital 2, Ho Chi Minh City, Vietnam. 14. YRGCARE Medical Centre, CART CRS, Chennai, India. 15. Hospital Raja Perempuan Zainab II, Kelantan, Malaysia. 16. Hospital Likas, Kota Kinabalu, Malaysia. 17. Sanglah Hospital, Udayana University, Bali, Indonesia. 18. TREAT Asia/amfAR - The Foundation for AIDS Research, Bangkok, Thailand.
Abstract
BACKGROUND: Perinatally HIV-infected adolescents (PHIVA) are exposed to a chronic systemic infection and long-term antiretroviral therapy (ART), leaving them susceptible to morbidities associated with inflammation, immunodeficiency and drug toxicity. METHODS: Data collected 2001 to 2016 from PHIVA 10-19 years of age within a regional Asian cohort were analyzed using competing risk time-to-event and Poisson regression analyses to describe the nature and incidence of morbidity events and hospitalizations and identify factors associated with disease-related, treatment-related and overall morbidity. Morbidity was defined according to World Health Organization clinical staging criteria and U.S. National Institutes of Health Division of AIDS criteria. RESULTS: A total 3,448 PHIVA contributed 17,778 person-years. Median age at HIV diagnosis was 5.5 years, and ART initiation was 6.9 years. There were 2,562 morbidity events and 307 hospitalizations. Cumulative incidence for any morbidity was 51.7%, and hospitalization was 10.0%. Early adolescence was dominated by disease-related infectious morbidity, with a trend toward noninfectious and treatment-related morbidity in later adolescence. Higher overall morbidity rates were associated with a CD4 count <350 cells/µL, HIV viral load ≥10,000 copies/mL and experiencing prior morbidity at age <10 years. Lower overall morbidity rates were found for those 15-19 years of age compared with 10-14 years and those who initiated ART at age 5-9 years compared with <5 or ≥10 years. CONCLUSIONS: Half of our PHIVA cohort experienced a morbidity event, with a trend from disease-related infectious events to treatment-related and noninfectious events as PHIVA age. ART initiation to prevent immune system damage, optimize virologic control and minimize childhood morbidity are key to limiting adolescent morbidity.
BACKGROUND: Perinatally HIV-infected adolescents (PHIVA) are exposed to a chronic systemic infection and long-term antiretroviral therapy (ART), leaving them susceptible to morbidities associated with inflammation, immunodeficiency and drug toxicity. METHODS: Data collected 2001 to 2016 from PHIVA 10-19 years of age within a regional Asian cohort were analyzed using competing risk time-to-event and Poisson regression analyses to describe the nature and incidence of morbidity events and hospitalizations and identify factors associated with disease-related, treatment-related and overall morbidity. Morbidity was defined according to World Health Organization clinical staging criteria and U.S. National Institutes of Health Division of AIDS criteria. RESULTS: A total 3,448 PHIVA contributed 17,778 person-years. Median age at HIV diagnosis was 5.5 years, and ART initiation was 6.9 years. There were 2,562 morbidity events and 307 hospitalizations. Cumulative incidence for any morbidity was 51.7%, and hospitalization was 10.0%. Early adolescence was dominated by disease-related infectious morbidity, with a trend toward noninfectious and treatment-related morbidity in later adolescence. Higher overall morbidity rates were associated with a CD4 count <350 cells/µL, HIV viral load ≥10,000 copies/mL and experiencing prior morbidity at age <10 years. Lower overall morbidity rates were found for those 15-19 years of age compared with 10-14 years and those who initiated ART at age 5-9 years compared with <5 or ≥10 years. CONCLUSIONS: Half of our PHIVA cohort experienced a morbidity event, with a trend from disease-related infectious events to treatment-related and noninfectious events as PHIVA age. ART initiation to prevent immune system damage, optimize virologic control and minimize childhood morbidity are key to limiting adolescent morbidity.
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