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Title: Characteristics, mortality and outcomes at transition for adolescents with perinatal HIV infection in Asia
Authors: Adam W. Bartlett
Khan Huu Truong
Wipaporn Natalie Songtaweesin
Kulkanya Chokephaibulkit
Rawiwan Hansudewechakul
Penh Sun Ly
Pagakrong Lumbiganon
Tavitiya Sudjaritruk
Lam Van Nguyen
Viet Chau Do
Nagalingeswaran Kumarasamy
Nik Khairulddin Nik Yusoff
Nia Kurniati
Moy Siew Fong
Dewi Kumara Wati
Revathy Nallusamy
Annette H. Sohn
Matthew G. Law
Thahira Jamal Mohamed
Keywords: Immunology and Microbiology
Issue Date: 1-Jan-2018
Abstract: Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved. Objectives: The aim of this study was to describe characteristics of perinatally HIV-infected adolescents (PHIVAs), factors associated with mortality, and outcomes at transition. Design: Ongoing observational database collating clinical data on HIV-infected children and adolescents in Asia. Methods: Data from 2001 to 2016 relating to adolescents (10-19 years) with perinatal HIV infection were analysed to describe characteristics at adolescent entry and transition and combination antiretroviral therapy (cART) regimens across adolescence. A competing risk regression analysis was used to determine characteristics at adolescent entry associated with mortality. Outcomes at transition were compared on the basis of age at cART initiation. Results: Of 3448 PHIVA, 644 had reached transition. Median age at HIV diagnosis was 5.5 years, cART initiation 7.2 years and transition 17.9 years. At adolescent entry, 35.0% hadCD4+ cell count less than 500 cells/ml and 51.1% had experience da WHO stage III/IV clinical event. At transition, 38.9% had CD4+ cell count less than 500copies/ml, and 53.4% had experienced a WHO stage III/IV clinical event. Mortality ratewas 0.71 per 100 person-years, with HIV RNA >1000copies/ml, CD4+ cell count less than 500cells/ml, height-for-ageorweight-for-agez-score less than - 2, historyofa WHO stage III/IV clinical event or hospitalization and at least second cART associated with mortality. For transitioning PHIVA, those who commenced cART age less than 5 years had better virologic and immunologic outcomes, though were more likely to be on at least second cART. Conclusion: Delayed HIV diagnosis and cART initiation resulted in considerable morbidity and poor immune status by adolescent entry. Durable first-line cART regimens to optimize disease control are key to minimizing mortality. Early cART initiation provides the best virologic and immunologic outcomes at transition.
ISSN: 14735571
Appears in Collections:CMUL: Journal Articles

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