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PLoS Med. 2018 Mar 1;15(3):e1002514. doi: 10.1371/journal.pmed.1002514. eCollection 2018 Mar.

The epidemiology of adolescents living with perinatally acquired HIV: A cross-region global cohort analysis.

Author information

1
Center for Infectious Diseases Epidemiology and Research, University of Cape Town, Cape Town, South Africa.
2
Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America.
3
Epicentre, Médecins Sans Frontières, Paris, France.
4
Baylor International Pediatric AIDS Initiative, Texas Children's Hospital-USA, Houston, Texas, United States of America.
5
Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
6
MRC Clinical Trials Unit at University College London, London, United Kingdom.
7
Yopougon University Hospital, University Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire.
8
Baylor International Pediatric AIDS Initiative, Kampala, Uganda.
9
School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.
10
ICAP at Columbia University Mailman School of Public Health, New York, New York, United States of America.
11
Inserm (French Institute of Health and Medical Research), CESP UMR Villejuif, France.
12
Indiana University School of Medicine, Indianapolis, Indiana, United States of America.
13
College of Public Health, Ohio State University, Columbus, Ohio, United States of America.
14
National Institute of Child Health and Human Development (NICHD), US National Institutes of Health, Rockville, Maryland, United States of America.
15
Tulane University, New Orleans, Louisiana, United States of America.
16
Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa.
17
Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, United States of America.
18
International AIDS Society, Geneva, Switzerland.
19
UNICEF, New York, New York, United States of America.
20
World Health Organization, Geneva, Switzerland.
21
Baylor International Pediatric AIDS Initiative, Gaborone, Botswana.
22
Baylor International Pediatric AIDS Initiative, Maseru, Lesotho.
23
Baylor International Pediatric AIDS Initiative, Lilongwe, Malawi.
24
Baylor International Pediatric AIDS Initiative, Mbabane, Swaziland.
25
Baylor International Pediatric AIDS Initiative, Mbeya, Tanzania.
26
Hospital St Pierre Cohort, Bruxelles, Belgium.
27
Institute of Child Health, University College London, London, United Kingdom.
28
Department of Health Sciences, University of Florence, Florence, Italy.
29
Erasmus MC University Medical Center Rotterdam-Sophia Children's Hospital, Rotterdam, the Netherlands.
30
PENTA Foundation, Padova, Italy.
31
Medical University of Warsaw, Hospital of Infectious Diseases in Warsaw, Warsaw, Poland.
32
Centro Hospitalar do Porto, Porto, Portugal.
33
Hospital de Santa Maria/CHLN, Lisbon, Portugal.
34
Victor Babes Hospital, Bucharest, Romania.
35
Republican Hospital of Infectious Diseases, St Petersburg, Russian Federation.
36
Hospital Doce de Octubre, Madrid, Spain.
37
Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain.
38
Karolinska University Hospital, Stockholm, Sweden.
39
University Children's Hospital, Basel, Switzerland.
40
Institut de Recherche pour le Développement (IRD) 174/PHPT, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand.
41
Institut National d'Etudes Démograhiques (Ined), F-75020 Paris, France.
42
Shupyk National Medical Academy of Postgraduate Education, Kiev, Ukraine.
43
GHESKIO Center, Port-au-Prince, Haiti.
44
Universidade Federal de São Paulo, São Paulo, Brazil.
45
TREAT Asia/amfAR, Bangkok, Thailand.
46
Kirby Institute, UNSW, Sydney, Australia.
47
Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.
48
Pediatric Hospital Kalembe Lembe, Lingwala, Kinshasa, Democratic Republic of Congo.
49
Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
50
Family AIDS Care and Education Services, Kenya Medical Research Institute, Kisumu, Kenya.
51
SolidarMed Lesotho, Mozambique and Zimbabwe, Lucerne, Switzerland.
52
Lighthouse Trust Clinic, Lilongwe, Malawi.
53
Center for Infectious Disease Research in Zambia, Lusaka, Zambia.
54
Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
55
Harriet Shezi Children's Clinic, Chris Hani Baragwanath Hospital, Johannesburg, South Africa.
56
University of Ghana School of Medicine and Dentistry, Accra, Ghana.
57
CHU Gabriel Touré, Bamako, Mali.
58
University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, United States of America.
59
Rutgers New Jersey Medical School, Newark, New Jersey, United States of America.
60
Bronx-Lebanon Hospital Center (Icahn School of Medicine at Mount Sinai), Bronx, New York, United States of America.
61
Feinberg School of Medicine, Northwestern University, Evanston, Illinois, United States of America.
62
Inserm (French Institute of Health and Medical Research), UMR 1027 Université Toulouse 3, Toulouse, France.

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.

PMID:
29494593
PMCID:
PMC5832192
DOI:
10.1371/journal.pmed.1002514
[Indexed for MEDLINE]
Free PMC Article

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