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dc.contributor.authorAmy L. Slogroveen_US
dc.contributor.authorMichael Schomakeren_US
dc.contributor.authorMary Ann Daviesen_US
dc.contributor.authorPaige Williamsen_US
dc.contributor.authorSuna Balkanen_US
dc.contributor.authorJihane Ben-Farhaten_US
dc.contributor.authorNancy Callesen_US
dc.contributor.authorKulkanya Chokephaibulkiten_US
dc.contributor.authorCharlotte Duffen_US
dc.contributor.authorTanoh François Ebouaen_US
dc.contributor.authorAdeodata Kekitiinwa-Rukyalekereen_US
dc.contributor.authorNicola Maxwellen_US
dc.contributor.authorJorge Pintoen_US
dc.contributor.authorGeorge Seageen_US
dc.contributor.authorChloe A. Teasdaleen_US
dc.contributor.authorSebastian Wanlessen_US
dc.contributor.authorJosiane Warszawskien_US
dc.contributor.authorKara Wools-Kaloustianen_US
dc.contributor.authorMarcel Yotebiengen_US
dc.contributor.authorVenessa Timmermanen_US
dc.contributor.authorIntira J. Collinsen_US
dc.contributor.authorRuth Goodallen_US
dc.contributor.authorColette Smithen_US
dc.contributor.authorKunjal Patelen_US
dc.contributor.authorMary Paulen_US
dc.contributor.authorDiana Gibben_US
dc.contributor.authorRachel Vreemanen_US
dc.contributor.authorElaine J. Abramsen_US
dc.contributor.authorRohan Hazraen_US
dc.contributor.authorRussell Van Dykeen_US
dc.contributor.authorLinda Gail Bekkeren_US
dc.contributor.authorLynne Mofensonen_US
dc.contributor.authorMarissa Vicarien_US
dc.contributor.authorShaffiq Essajeeen_US
dc.contributor.authorMartina Penazzatoen_US
dc.contributor.authorGabriel Anabwanien_US
dc.contributor.authorEdith Q. Mohapien_US
dc.contributor.authorPeter N. Kazembeen_US
dc.contributor.authorMakhosazana Hlatshwayoen_US
dc.contributor.authorMwita Lumumbaen_US
dc.contributor.authorTessa Goetghebueren_US
dc.contributor.authorClaire Thorneen_US
dc.contributor.authorLuisa Gallien_US
dc.contributor.authorAnnemarie van Rossumen_US
dc.contributor.authorCarlo Giaquintoen_US
dc.contributor.authorMagdalena Marczynskaen_US
dc.contributor.authorLaura Marquesen_US
dc.contributor.authorFilipa Prataen_US
dc.contributor.authorLuminita Eneen_US
dc.contributor.authorLiubov Okhonskaiaen_US
dc.contributor.authorPablo Rojoen_US
dc.contributor.authorClaudia Fortunyen_US
dc.contributor.authorLars Naveren_US
dc.contributor.authorChristoph Rudinen_US
dc.contributor.authorSophie Le Coeuren_US
dc.contributor.authorAlla Volokhaen_US
dc.contributor.authorVanessa Rouzieren_US
dc.contributor.authorRegina Succien_US
dc.contributor.authorAnnette Sohnen_US
dc.contributor.authorAzar Kariminiaen_US
dc.contributor.authorAndrew Edmondsen_US
dc.contributor.authorPatricia Leloen_US
dc.contributor.authorSamuel Ayayaen_US
dc.contributor.authorPatricia Ongwenen_US
dc.contributor.authorLaura F. Jefferysen_US
dc.contributor.authorSam Phirien_US
dc.contributor.authorMwangelwa Mubiana-Mbeween_US
dc.contributor.authorShobna Sawryen_US
dc.contributor.authorLorna Renneren_US
dc.contributor.authorMariam Syllaen_US
dc.contributor.authorMark J. Abzugen_US
dc.contributor.authorMyron Levinen_US
dc.contributor.authorJames Oleskeen_US
dc.contributor.authorMiriam Chernoffen_US
dc.contributor.authorShirley Traiteen_US
dc.contributor.authorMurli Purswanien_US
dc.contributor.authorEllen G. Chadwicken_US
dc.contributor.authorAli Judden_US
dc.contributor.authorValériane Leroyen_US
dc.description.abstract© 2018 The Collaborative Initiative for Paediatric HIV Education and Research (CIPHER) Global Cohort Collaboration et al. 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.en_US
dc.titleThe epidemiology of adolescents living with perinatally acquired HIV: A cross-region global cohort analysisen_US
article.title.sourcetitlePLoS Medicineen_US
article.volume15en_US of Cape Townen_US School of Public Healthen_US Sans Frontieresen_US Children's Hospital Houstonen_US Universityen_US Clinical Trials Uniten_US University Hospitalen_US International Pediatric AIDS Initiativeen_US Federal de Minas Geraisen_US University Medical Centeren_US University School of Medicine Indianapolisen_US State Universityen_US Institute of Child Health and Human Developmenten_US Universityen_US Glaser Pediatric AIDS Foundationen_US Mondiale de la Santeen_US International Pediatric AIDS Initiativeen_US International Pediatrics AIDS Initiativeen_US International Pediatric AIDS Initiativeen_US International Pediatric AIDS Initiativeen_US Pediatric International AIDS Initiativeen_US Hospitalier Universitaire Saint Pierre, Brusselsen_US Institute of Child Healthen_US degli Studi di Firenzeen_US University Medical Centeren_US Foundationen_US University of Warsawen_US Hospitalar do Portoen_US Maria Hospital, Lisbonen_US Babes National Instituteen_US Hospital of Infectious Diseases Clinical AIDS Centeren_US Universitario 12 de Octubreen_US de Barcelonaen_US University Hospitalen_US beider Baselen_US Mai Universityen_US Institut National d' Etudes Demographiquesen_US National Medical Academy of Postgraduate Educationen_US Centersen_US Federal de Sao Pauloen_US Asia/amfAR-The Foundation for AIDS Researchen_US of New South Wales (UNSW) Australiaen_US University of North Carolina at Chapel Hillen_US Hospital Kalembe Lembeen_US Model Providing Access to Healthcareen_US AIDS Care and Education Services Medical Research Instituteen_US Lesothoen_US Trusten_US for Infectious Disease Research in Zambiaen_US of Witwatersranden_US Hospitalen_US of Ghanaen_US Gabriel Touréen_US of Colorado School of Medicineen_US New Jersey Medical Schoolen_US School of Medicine at Mount Sinaien_US University Feinberg School of Medicineen_US
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