title: Health Outcomes of International HIV-infected Adoptees in the US.
abstract: BACKGROUND
  International adoption of HIV-infected children is becoming increasingly common. Their health has not yet been described.
  
  
  METHODS
  HIV-infected international adoptees or refugees in foster care aged 0-20 years followed at Seattle Children's Hospital or Children's Hospital Colorado between January 1, 2004 and May 31, 2013 were included. Parameters were collected through retrospective chart review of baseline (first 6 months at study site) and annual follow-up visits.
  
  
  RESULTS
  Africa (90%) was the primary region of origin for the 79 children who met inclusion criteria. Median follow-up was 3 years (range: 0-7). At baseline, acute malnutrition was uncommon (8%); however, stunting occurred in 32%. Most stunting resolved during the study period. The most common medical issues at baseline were dermatologic (Tinea and Molluscum contagiosum) and gastrointestinal (parasites and diarrhea). Almost half (48%) had either mental health issues or behavioral problems. Educational delays (50%) were also common. Upon adoption, only 1% was severely (CD4% < 15%) immunosuppressed. Fifty-nine (75%) were on antiretroviral therapy (ART); 45 of these (76%) had suppressed viral load (VL). Of 14 children on ART with detectable VL, 11 (79%) demonstrated non-nucleoside reverse transcriptase inhibitor resistance and 1 (7%) protease inhibitor resistance.
  
  
  CONCLUSIONS
  In this cohort of HIV-infected international adoptees, severe immunosuppression was uncommon. Most medical issues were mild. Stunting was common at baseline but largely resolved. Mental health issues, behavioral problems, and educational delays were common. Most children were on ART at adoption and most of these showed suppressed VL. Non-nucleoside reverse transcriptase inhibitor mutations were present in most viremic children.
authors.affiliation: From the *Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington; †Seattle Children's Research Institute, Seattle, Washington; ‡Division of Urgent Care, Seattle Children's Hospital, Seattle, Washington; §Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; ¶Division of Infectious Diseases, Children's Hospital Colorado, Aurora, Colorado; and llDivision of Infectious Diseases, Seattle Children's Hospital, Seattle, Washington.
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Wolf
authors.forename: Sara
authors.initials: S
authors.lastname: Beste
authors.forename: Emily
authors.initials: E
authors.lastname: Barr
authors.forename: Jenna
authors.initials: J
authors.lastname: Wallace
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: McFarland
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Abzug
authors.forename: Juliana
authors.initials: J
authors.lastname: Darrow
authors.forename: Ann
authors.initials: A
authors.lastname: Melvin
mesh_terms: D000293:Adolescent; D000300:Adoption; D023241:Antiretroviral Therapy, Highly Active; D002648:Child; D002675:Child, Preschool; D060085:Coinfection; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D044342:Malnutrition; D063868:Patient Outcome Assessment; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D055815:Young Adult