Long-term nonprogression of HIV infection in children: evaluation of the ANRS prospective French Pediatric Cohort.
ABSTRACT Some children who are infected with human immunodeficiency virus type 1 (HIV-1) during the perinatal period remain asymptomatic for very long periods in the absence of antiretroviral treatment, as is the case for some adults. Our objective was to estimate the proportion of children who developed neither symptoms nor major immunological perturbations to the age of > or = 10 years in a prospective cohort of infected children who had been observed since birth.
The ongoing prospective French Pediatric Cohort includes 568 HIV-1-infected children. Here, we report the follow-up data for all 348 HIV-1-infected children who were born before 1 January 1994. Children with long-term nonprogression of infection (LTNPs) were defined as HIV-1-infected children who had been observed for at least 10 years, never received antiretroviral treatment other than zidovudine monotherapy, never developed symptoms of Centers for Disease Control and Prevention clinical category C or B, and had a CD4+ cell percentage of < 25% no more than once during follow-up. Other definitions were compared.
The Kaplan-Meier estimate of long-term nonprogression was 2.4% (95% confidence interval, 1.1%-4.6%) at 10 years of age, and 7 children were classified as LTNPs. The Kaplan-Meier estimates decreased slightly with age, to 1.8% at 12 years of age and 1.4% at 14 years of age. Plasma HIV-1 replication rates were low (< 1000 copies RNA/mL) for 2 of the 7 LTNPs at the age of 10 years (0.6% of the total denominator). None of the routinely measured maternal or perinatal markers were significantly linked to long-term nonprogression, with the exception of the mother's Centers for Disease Control and Prevention clinical category at the time of delivery.
Approximately 2% of children who were infected during the perinatal period displayed no immunological or clinical progression by the age of 10 years. This figure is close to that reported for adults in studies that have used similar definitions.
- Medicina Clínica 04/2009; 132(13):505-506. DOI:10.1016/j.medcli.2008.12.021 · 1.25 Impact Factor
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ABSTRACT: As antiretroviral treatment (ART) becomes more readily available to children in sub-Saharan Africa (SSA), it is important that the experiences of children and their caretakers be carefully examined from more than just a logistical perspective. This paper is based upon an original exploratory and qualitative study that focused on ART in Mozambique. Through in-depth semi-structured interviews, the study examined the experiences of 26 caretakers—primarily mothers—of pediatric patients aged 3-12 receiving ART through the Pediatric Day Hospital of the Maputo Central Hospital (Mozambique) as well as those of their clinicians (7 physicians and 2 dedicated nurses). The interviews focused on the effect of standard HIV prevention communications on pediatric treatment-seeking and ART adherence via several mediating factors such as: 1) Caretakers’ sources of HIV information and their perceived reliability; 2) Levels of trust and communication between providers and patients/caretakers related to the completeness of discussions dealing with HIV risk factors and modes of transmission (particularly for the 19% of mothers interviewed who were uninfected themselves) and; 3) The potential propagation of shame and fear through HIV prevention messages which may contribute to sub-optimal adherence (marked, for example, by fear of involuntary disclosure to others in the child’s household). The results indicate that all three of these mediating factors deserve further attention as caretakers did, indeed, report adverse effects on initial treatment-seeking and adherence for the children in their care broadly linked with these factors. As patients and their caretakers often must progress through several counseling sessions before or during commencement of ART, there is ample opportunity for these interpersonal and psychosocial factors to be addressed without the need for further financial or human resource allocations.Children and Youth Services Review 10/2014; 45. DOI:10.1016/j.childyouth.2014.03.039 · 1.27 Impact Factor
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ABSTRACT: BACKGROUND. Increasing numbers of children perinatally infected with human immunodeficiency virus (HIV) are reaching adolescence, largely because of advances in treatment over the past 10 years, but little is known about their current health status. We describe here the living conditions and clinical and immunovirologic outcomes at last evaluation among this pioneering generation of adolescents who were born before the introduction of prophylaxis for vertical transmission and whose infections were diagnosed at a time when treatment options were limited. METHODS. The eligible population consisted of HIV-1-infected children who were born before December 1993 and who were included at birth in the prospective national French Perinatal Cohort (EPF/ANRS CO10). RESULTS. Of the 348 eligible children, 210 (60%; median age, 15 years) were still alive and regularly followed up. Current treatment was highly active antiretroviral therapy (HAART) in 77% and 2 nucleoside analogues in 5.0%; 16% had stopped treatment, and 2% had never been treated. The median CD4 cell count was 557 cells/microL, and 200 cells/microL was exceeded in 94% of patients. The median viral load was 200 copies/mL. Viral load was undetectable in 43% of the adolescents and in 54.5% of those receiving HAART. Median height, weight, and body mass index were similar to French reference values for age, and school achievement was similar to nationwide statistics. Better immunologic status was associated with being younger and with having begun HAART earlier. Undetectable viral load was associated with maternal geographic origin and current HAART. CONCLUSIONS. Given the limited therapeutic options available during the early years of these patients' lives and the challenge presented by treatment adherence during adolescence, the long-term outcomes among this population are encouraging.Clinical Infectious Diseases 07/2010; 51(2):214-24. DOI:10.1086/653674 · 9.42 Impact Factor