Characterizing HIV manifestations and treatment outcomes of perinatally infected adolescents in Asia.
BACKGROUND
More perinatally HIV-infected children in Asia are reaching adolescence.


METHODS
We analyzed data from July 1991 to March 2011 reported by 18 clinics in 6 countries of children age >12 years.


RESULTS
Of 1254 adolescents, 33 (2.6%) died, and 52 (4.1%) were lost to follow-up within 2.4-year (3566 person-years) median follow-up period. Of 1061 adolescents under active follow-up, 485 (46%) were male, median (interquartile range) age was 14.7 (13.3-16.4) years, 73% had lost a parent(s), 93% attended school and 62% were aware of their HIV status. At the most recent evaluation, 93% were receiving highly active antiretroviral therapy, 71% (N = 737/1035) had CD4 ≥ 500 cells/mm(3) and 87% (N = 718/830) had viral load (VL) <400 copies/mL. Current CD4 ≥ 200 cells/mm(3), no previous World Health Organization stage 3 or 4 and being on a first-line regimen were independently associated with recent VL <400 copies/mL. Current age <15 years, VL <400 copies/mL, CD4 15-24% (vs. <10%) at antiretroviral therapy initiation, no previous World Health Organization stage 3 or 4 and antiretroviral therapy duration of ≥ 1 year were associated with recent CD4 ≥ 500 cells/mm(3). Primary causes of death after age 12 were opportunistic infections (N = 15/33) and other AIDS- or treatment-related conditions (N = 9/33). Those at age 12 with CD4 <200 versus ≥ 500 cells/mm and those with VL ≥ 10,000 versus <10,000 copies/mL were 17.4 and 4.76 times more likely to die in adolescence, respectively.


CONCLUSIONS
Adolescents in this cohort have been successfully maintained in HIV care. Initiating treatment at earlier stages of disease was associated with immune recovery and virologic suppression during adolescence.
From the *Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; †Biostatistics and Databases Program, The Kirby Institute, Faculty of Medicine, The University of New South Wales, Sydney, Australia; ‡Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; §Penang Hospital, Penang, Malaysia; ¶HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok; ‖Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand; **National Hospital of Pediatrics, Hanoi, Vietnam; ††National Centre for HIV/AIDS Dermatology and STDs, Phnom Penh, Cambodia; ‡‡YR Gaitonde Centre for AIDS Research and Education, Chennai, India; §§Khon Kaen University, Khon Kaen, Thailand; ¶¶Children's Hospital 2, Ho Chi Minh City, Vietnam; ‖‖Cipto Mangunkusumo General Hospital, Jakarta, Indonesia; ***Hospital Raja Perempuan Zainab II, Kelantan; †††Pediatric Institute, Hospital Kuala Lumpur, Kuala Lumpur; ‡‡‡Hospital Likas, Kota Kinabalu, Malaysia; §§§Children's Hospital 1, Ho Chi Minh City, Vietnam; ¶¶¶Sanglah Hospital, Udayana University, Bali, Indonesia; and ‖‖‖TREAT Asia/amfAR - The Foundation for AIDS Research, Bangkok, Thailand.
Kulkanya
K
Chokephaibulkit
Azar
A
Kariminia
Peninnah
P
Oberdorfer
Revathy
R
Nallusamy
Torsak
T
Bunupuradah
Rawiwan
R
Hansudewechakul
Khu Thi Khanh
KT
Dung
Vonthanak
V
Saphonn
Nagalingeswaran
N
Kumarasamy
Pagakrong
P
Lumbiganon
Do Chau
do C
Viet
Nia
N
Kurniati
Nik Khairuddin Nik
NK
Yusoff
Kamarul
K
Razali
Siew Moy
SM
Fong
Truong Huu
TH
Khanh
Dewi Kumara
DK
Wati
Annette H
AH
Sohn
D000293:Adolescent; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D001210:Asia, Southeastern / Q000453:epidemiology; D002648:Child; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology* / Q000276:immunology / Q000401:mortality; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome
D044966:Anti-Retroviral Agents