期刊
PLOS MEDICINE
卷 15, 期 3, 页码 -出版社
PUBLIC LIBRARY SCIENCE
DOI: 10.1371/journal.pmed.1002514
关键词
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资金
- CIPHER Founding Sponsor ViiV Healthcare
- Janssen
- United States (US) National Institutes of Health (NIH) [U01A1069923]
- US NIH [U01AI069907, U01AI096299-07, U01-A1069911, U01-AI069924, U01AI069919, UM1AI068616, UM1AI068632, U01 HD052102, U01 HD052104]
- President's Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention [5U62PS223540, 5U2GPS001537]
- EuroCoord [260694]
- PENTA Foundation
- Medical Research Council [MC_UU_12023/26]
- ATHENA
- Dutch Ministry of Health, Welfare and Sport through the Centre for Infectious Disease Control of the National Institute for Public Health and the Environment
- Institute de Salud Carlos III through the Red Tematica de Investigacion Cooperativa en Sida
- Fundacion para la Investigacion y Prevencion de SIDA en Espana (FIPSE) [FIPSE 3608229/09, FIPSE 240800/09, FIPSE 361910/10]
- Institute de Salud Carlos III (ISCIII), Plan R+D+I [RD12/0017/0035, RD12/0017/0037]
- ISCIII-Subdireccion General de Evaluacion
- Fondo Europeo de Desarrollo Regional (FEDER)
- Mutua Madrilena [2012/0077]
- Gilead Fellowship [2013/0071]
- FIS [PI15/00694]
- CoRISpe [RED RIS RD06/0006/0035, RD06/0006/0021]
- Swiss National Science Foundation [148522]
- SHCS research foundation
- NHS
- Bristol-Myers Squibb
- Boehringer Ingelheim
- GlaxoSmithKline
- Roche
- Abbott
- Gilead Sciences
- MRC [MC_UU_12023/26, MC_UU_12023/17] Funding Source: UKRI
- Medical Research Council [MC_UU_12023/17] Funding Source: researchfish
- EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE OF CHILD HEALTH & HUMAN DEVELOPMENT [U01HD052102, U01HD052104] Funding Source: NIH RePORTER
- NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES [U01AI069924, U01AI069919, U01AI069907, UM1AI068616, U01AI069911] Funding Source: NIH RePORTER
Background & para;& para;Globally, the population of adolescents living with perinatally acquired HIV (APHs) continues to expand. In this study, we pooled data from observational pediatric HIV cohorts and cohort networks, allowing comparisons of adolescents with perinatally acquired HIV in real-life settings across multiple regions. We describe the geographic and temporal characteristics and mortality outcomes of APHs across multiple regions, including South America and the Caribbean, North America, Europe, sub-Saharan Africa, and South and Southeast Asia.& para;& para;Methods and findings & para;& para;Through the Collaborative Initiative for Paediatric HIV Education and Research (CIPHER), individual retrospective longitudinal data from 12 cohort networks were pooled. All children infected with HIV who entered care before age 10 years, were not known to have horizontally acquired HIV, and were followed up beyond age 10 years were included in this analysis conducted from May 2016 to January 2017. Our primary analysis describes patient and treatment characteristics of APHs at key time points, including first HIV-associated clinic visit, antiretroviral therapy (ART) start, age 10 years, and last visit, and compares these characteristics by geographic region, country income group (CIG), and birth period. Our secondary analysis describes mortality, transfer out, and lost to follow-up (LTFU) as outcomes at age 15 years, using competing risk analysis. Among the 38,187 APHs included, 51% were female, 79% were from sub-Saharan Africa and 65% lived in low-income countries. APHs from 51 countries were included (Europe: 14 countries and 3,054 APHs; North America: 1 country and 1,032 APHs; South America and the Caribbean: 4 countries and 903 APHs; South and Southeast Asia: 7 countries and 2,902 APHs; sub-Saharan Africa, 25 countries and 30,296 APHs). Observation started as early as 1982 in Europe and 1996 in sub-Saharan Africa, and continued until at least 2014 in all regions. The median (interquartile range [IQR]) duration of adolescent follow-up was 3.1 (1.5-5.2) years for the total cohort and 6.4 (3.6-8.0) years in Europe, 3.7 (2.0-5.4) years in North America, 2.5 (1.2-4.4) years in South and Southeast Asia, 5.0 (2.7-7.5) years in South America and the Caribbean, and 2.1 (0.9-3.8) years in sub-Saharan Africa. Median (IQR) age at first visit differed substantially by region, ranging from 0.7 (0.3-2.1) years in North America to 7.1 (5.38.6) years in sub-Saharan Africa. The median age at ART start varied from 0.9 (0.4-2.6) years in North America to 7.9 (6.0-9.3) years in sub-Saharan Africa. The cumulative incidence estimates (95% confidence interval [Cl]) at age 15 years for mortality, transfers out, and LTFU for all APHs were 2.6% (2.4%-2.8%), 15.6% (15.1%-16.0%), and 11.3% (10.9%-11.8%), respectively. Mortality was lowest in Europe (0.8% [0.5%-1.1%]) and highest in South America and the Caribbean (4.4% [3.1%-6.1%]). However, LTFU was lowest in South America and the Caribbean (4.8% [3.4%-6.7%]) and highest in sub-Saharan Africa (13.2% [12.6%-13.7%]). Study limitations include the high LTFU rate in sub-Saharan Africa, which could have affected the comparison of mortality across regions; inclusion of data only for APHs receiving ART from some countries; and unavailability of data from high-burden countries such as Nigeria. & para;& para;Conclusion & para;& para;To our knowledge, our study represents the largest multiregional epidemiological analysis of APHs. Despite probable under-ascertained mortality, mortality in APHs remains substantially higher in sub-Saharan Africa, South and Southeast Asia, and South America and the Caribbean than in Europe. Collaborations such as CIPHER enable us to monitor current global temporal trends in outcomes over time to inform appropriate policy response.
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