Data on health of adolescents with perinatal HIV-1 infection encouraging

Most adolescents with HIV-1 infection had good immunologic profiles and grew at the same rate and performed on the same level academically as those without the disease, according to recent study data.

“Major improvements in access to antiretroviral therapy (ART) have made it possible for children perinatally infected with human immunodeficiency virus (HIV) to reach adolescence — and even adulthood — in increasing numbers,” researchers from several sites in France wrote. “However, little is known about the current health status of this population.”

To assess the progress of children with perinatal HIV-1 infection who survived to adolescence, the researchers examined follow-up information on children enrolled in a national prospective multicenter cohort — the French Perinatal Cohort (EPF) — that studies pregnant women with HIV-1 and their children.

Data collection began in 1985 and is ongoing. The researchers, however, confined their analysis to children born before 1994. HIV-1 infection in infants was determined by positive virologic tests from two separate samples, the presence of anti-HIV-1 antibodies after 18 months or, in the absence of virus isolation, AIDS-related death before 18 months. Clinical and biological information for children with HIV were gathered via questionnaires administered at 6-month intervals through 18 years of age.

Sixty percent of the 348 children, with a median age of 15 years, who met inclusion criteria were alive and completed regular follow-up, according to the researchers. Results indicated that 77% were currently receiving antiretroviral therapy (ART). Protease inhibitors, nonnucleoside reverse-transcriptase inhibitors and a combination of the two comprised most treatment regimens. The researchers reported, however, that 16% had stopped ART by the last evaluation, with very poor compliance and slow progression in patients serving as the most common reasons. The researchers added that 2% of adolescents had never received treatment.

Immunovirologic data showed that the median CD4 cell count was 557 cells/mcL (interquartile range=382-861), with 6.6% of patients having CD4 cell counts below 200/mcL. The researchers noted that 43.3% of adolescents had optimal viral control, and 59.1% had optimal immunologic status. Results also revealed an association between younger age and earlier initiation of ART with better immunologic outcomes.

The adolescents’ median weight z score was 0.11 for age, according to the researchers, and median height and BMI z scores were -0.02 and 0.02 respectively. These numbers remained stable from childhood to 15 years and did not deviate from French national reference values.

Of the 179 adolescents with academic performance or occupational status data available, 84.3% were in general school. Fifteen percent repeated at least two grades, and 2.2% dropped out of school. Another 2.7% required special education, while 12.8% opted for vocational training. The researchers noted that the academic failure rate, 16.5%, was also consistent with that of the general population.

Data also showed that 81.5% of the adolescents were living with family members, while 65% were living with at least one parent. Fifty-four percent had mothers who were still alive, although 12% lived with other caretakers despite their mothers’ health status.

“The current health status of perinatally infected children followed from birth to adolescence (median duration of follow-up, 15 years) is encouraging, particularly given the limited therapeutic options available during the first few years of these individuals’ lives and the specific issues associated with treatment adherence in adolescents with chronic diseases,” wrote the researchers.

Dollfus C. Clin Infect Dis. 2010; 51:214-224.

Follow the PediatricSuperSite.com on Twitter.