Disease- and Treatment-related Morbidity in Adolescents With Perinatal HIV Infection in Asia

Pediatr Infect Dis J. 2019 Mar;38(3):287-292. doi: 10.1097/INF.0000000000002208.

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.

Publication types

  • Observational Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Antiretroviral Therapy, Highly Active / adverse effects*
  • Asia / epidemiology
  • Child
  • Chronic Disease / drug therapy
  • Chronic Disease / epidemiology*
  • Cohort Studies
  • Disease Susceptibility / epidemiology
  • Disease Susceptibility / virology
  • Female
  • HIV Infections / drug therapy*
  • HIV Infections / epidemiology*
  • Hospitalization / statistics & numerical data
  • Humans
  • Incidence
  • Infectious Disease Transmission, Vertical*
  • Male
  • Morbidity
  • Viral Load
  • Young Adult