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Title: The epidemiology of adolescents living with perinatally acquired HIV: A cross-region global cohort analysis
Authors: Amy L. Slogrove
Michael Schomaker
Mary Ann Davies
Paige Williams
Suna Balkan
Jihane Ben-Farhat
Nancy Calles
Kulkanya Chokephaibulkit
Charlotte Duff
Tanoh François Eboua
Adeodata Kekitiinwa-Rukyalekere
Nicola Maxwell
Jorge Pinto
George Seage
Chloe A. Teasdale
Sebastian Wanless
Josiane Warszawski
Kara Wools-Kaloustian
Marcel Yotebieng
Venessa Timmerman
Intira J. Collins
Ruth Goodall
Colette Smith
Kunjal Patel
Mary Paul
Diana Gibb
Rachel Vreeman
Elaine J. Abrams
Rohan Hazra
Russell Van Dyke
Linda Gail Bekker
Lynne Mofenson
Marissa Vicari
Shaffiq Essajee
Martina Penazzato
Gabriel Anabwani
Edith Q. Mohapi
Peter N. Kazembe
Makhosazana Hlatshwayo
Mwita Lumumba
Tessa Goetghebuer
Claire Thorne
Luisa Galli
Annemarie van Rossum
Carlo Giaquinto
Magdalena Marczynska
Laura Marques
Filipa Prata
Luminita Ene
Liubov Okhonskaia
Pablo Rojo
Claudia Fortuny
Lars Naver
Christoph Rudin
Sophie Le Coeur
Alla Volokha
Vanessa Rouzier
Regina Succi
Annette Sohn
Azar Kariminia
Andrew Edmonds
Patricia Lelo
Samuel Ayaya
Patricia Ongwen
Laura F. Jefferys
Sam Phiri
Mwangelwa Mubiana-Mbewe
Shobna Sawry
Lorna Renner
Mariam Sylla
Mark J. Abzug
Myron Levin
James Oleske
Miriam Chernoff
Shirley Traite
Murli Purswani
Ellen G. Chadwick
Ali Judd
Valériane Leroy
Keywords: Medicine
Issue Date: 1-Mar-2018
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.
ISSN: 15491676
Appears in Collections:CMUL: Journal Articles

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