Adolescents living with HIV. Clinical, demographic and social aspects. Buenos Aires, Argentina

Abstract

Background: Adolescents with HIV are a unique sub-population, most of them perinatally infected, who been subject to initial suboptimal antiretroviral treatments (ART). The understanding of the complex variables implicated in the evolution is important to optimize health strategies. Methods & Materials: Retrospective cohort study to evaluate living conditions, demographic, clinical and immunovirologic outcomes in HIV infected patients aged 10-19 years followed-up 2005-2017. Multivariate analysis was performed. Results: 240 patients were included, at last pediatric visit, median age:16.6 years old (y/o) [IQR:14.2-16.7], 64 were transferred to adult services, 232 (97%) were Perinatal HIV infected (PHIV); 67% had previous AIDS diagnosis, 60% had CD4 count > 500 cells/mm3, 53% had viral suppression and 15 (6%) died. Median time on ART was 13 years [IQR:9-16]. Mortality was associated to higher viral load (5.3 vs. 2.2 log) and lower CD4% (8% vs. 26%, p = 0.02). Median age at death: 17.8 y/o [IQR:13-21]. An AIDS diagnosis at any time was associated to HIV diagnosis at < 12 months old and to lower CD4 count (p < 0.001). They presented higher mortality than non-AIDS patients (10% vs 1%). Among 240 patients, 67% were orphans and 9% had dead HIV brothers/sisters. Inadequate education was detected in 49%, 7% reported drugs use and 3% delinquency. Among 81 sexually active patients (median age:17 y/o [IQR:15-18]), only 34% reported using a condom in intercourse and 57% reported to disclose their HIV status. Twenty-two PHIV infected females became pregnant, median age:17.5 y/o [IQR:17-19] resulting in 26 live births, data on 18 babies:1 HIV infected (5.6%). Good adherence was more frequent in < 15 y/o (73% vs. 56%) and was significantly associated to viral suppression and CD4 > 500 cells/mm3 (p < 0.001). Among 64 patients transferred to adult services (median age: 18.5 y/o [IQR:17-20]), 59% had AIDS, 46% had viral suppression and 58% CD4 > 500 cells/mm3. Of 57 patients with ART resistance data, 8% had resistance to 2 classes and 14% to three classes. Conclusion: In this series, patients were highly exposed to treatment, disease and adverse social conditions, nevertheless the outcome is encouraging. Good adherence was the best predictor of immunological recovery and viral suppression.