Health Status Among HIV-Infected International Adoptees

Abstract

Research Article| July 01 2016 Health Status Among HIV-Infected International Adoptees AAP Grand Rounds (2016) 36 (1): 10. https://doi.org/10.1542/gr.36-1-10 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Health Status Among HIV-Infected International Adoptees. AAP Grand Rounds July 2016; 36 (1): 10. https://doi.org/10.1542/gr.36-1-10 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: adopted child, hiv infections Wolf ER, Beste S, Barr E, et al. Health outcomes of international HIV-infected adoptees in the US. Pediatr Infect Dis J. 2015; 35(4): 422– 427; doi: https://doi.org/10.1097/INF.0000000000001020Google Scholar Investigators at Seattle Children’s Hospital and Children’s Hospital Colorado conducted a retrospective chart review to evaluate the health outcomes of HIV-infected international adoptees. Study participants were HIV-infected children 0–20 years old with a history of placement in refugee foster care or adoption from a country outside the United States, who received care from Seattle Children’s Virology Clinic or Children’s Hospital Colorado Immunodeficiency Program from 2004–2013. HIV infection was defined as either a positive HIV serology (if >18 months old) or positive HIV RNA or DNA assay (if ≤18 months old). Baseline demographic, clinical, and laboratory data were abstracted from the first 6 months of medical records at one of the study clinics. Baseline diagnoses were categorized into medical conditions, nutritional conditions (with malnutrition defined using WHO criteria and stunting defined as height for age ≤2 standard deviations from the WHO median), and mental and behavioral health conditions. New diagnoses were defined as occurring at 1 or more annual follow-up visits after the initial 6 months and were only counted once. There were 79 participants who met inclusion criteria. Most participants originated from Africa (90%) and had a median age of 6.1 years at baseline. Most participants (95%) were cared for in an orphanage prior to adoption or entry into refugee foster care. At baseline, participants had several medical diagnoses, including Tinea (28%), diarrhea (20%), molluscum contagiosum (19%), and giardia (19%). Only 1% had severe immunosuppression (CD4% <15%), and 75% were on antiretroviral therapy (ART). Of those on ART, 76% had suppressed viral load at baseline. Among those on ART with detectable viral load at baseline, 86% were resistant to ART. Malnutrition was present in 34% of participants, with stunting observed in 93% of those malnourished. At baseline, 8% of participants had diagnoses related to mental health and 25% had behavioral health diagnoses. Median follow-up was 3 years. The most common new medical diagnoses made during follow-up were neutropenia (16%), Tinea (10%), and chronic otitis media (10%). Several improvements in HIV treatment were observed at follow-up, including an increase to 92% of participants on ART, a decrease to 5% with moderate to severe immunosuppression, and 94% with suppressed viral load. Regarding malnutrition, 64% who were stunted at baseline were no longer stunted at follow-up. New mental and behavioral health diagnoses increased at follow-up to 19% and 36%, respectively. The authors conclude that most medical issues of HIV-infected adoptees are mild and severe immunosuppression is uncommon. Dr Todd has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. In 2014, there were an estimated 2.6 million children under 15 years of age living with HIV.1 Many of these children have been orphaned or are in the... You do not currently have access to this content.