Growth and CD4 patterns of adolescents living with perinatally acquired HIV worldwide, a CIPHER cohort collaboration analysis

Publication

Growth and CD4 patterns of adolescents living with perinatally acquired HIV worldwide, a CIPHER cohort collaboration analysis

Journal Paper/Review - Mar 1, 2022

Leroy Valériane, Succi Regina, Marcelin Adias, Rouzier Vanessa, Pape Jean William, Chappell Elizabeth, Volokha Alla, Kahlert Christian, Naver Lars, Frick Antoinette, Navarro Marisa, Okhonskaya Lyuba, Ene Luminita, Prata Filipa, Marques Laura, Marczynska Magdalena, Giaquinto Carlo, van Rossum Annemarie M C, Sohn Annette H, Kariminia Azar, Edmonds Andrew, Goodall Ruth, Nuwagaba-Biribonwoha Harriet, Teasdale Chloe, Purswani Murli, Oleske James, Abzug Mark J, Renner Lorna, D'Almeida Marceline, Sylla Mariam, Tweya Hannock, Muhairwe Josephine, Bolton Carolyn, Haas Andreas D, Odhiambo Francesca Akoth, Ogalo Edith Apondi, Lyamuya Rita, Lelo Patricia, Galli Luisa, Warszawski Josiane, Mofenson Lynne, Judd Ali, Van Dyke Russell, Ben-Farhat Jihane, Davies Mary-Ann, Vreeman Rachel, Paul Mary, Pinto Jorge, Patel Kunjal, Aké-Assi Marie-Hélène, Le Coeur Sophie, Chokephaibulkit Kulkanya, Abrams Elaine J, Yotebieng Marcel, Quartagno Matteo, Crichton Siobhan, Jesson Julie, Vicari Marissa, Seage George, Bekker Linda-Gail, Thorne Claire, Goetghebuer Tessa, Wanless Sebastian, Kekitiinwa-Rukyalekere Adeodata, Mwita Lumumba, Lukhele Bhekumusa, Nyasulu Phoebe, Thahane Lineo, Matshaba Mogomotsi, Williams Paige, Powis Kate, Slogrove Amy, Wools-Kaloustian Kara, Collins Intira Jeannie, Penazzato Martina, Gibb Diana, Essajee Shaffiq, Collaborative Initiative for Paediatric HIV Education and Research (CIPHER) Global Cohort Collaboration

Citation

Leroy V, Succi R, Marcelin A, Rouzier V, Pape J, Chappell E, Volokha A, Kahlert C, Naver L, Frick A, Navarro M, Okhonskaya L, Ene L, Prata F, Marques L, Marczynska M, Giaquinto C, van Rossum A, Sohn A, Kariminia A, Edmonds A, Goodall R, Nuwagaba-Biribonwoha H, Teasdale C, Purswani M, Oleske J, Abzug M, Renner L, D'Almeida M, Sylla M, Tweya H, Muhairwe J, Bolton C, Haas A, Odhiambo F, Ogalo E, Lyamuya R, Lelo P, Galli L, Warszawski J, Mofenson L, Judd A, Van Dyke R, Ben-Farhat J, Davies M, Vreeman R, Paul M, Pinto J, Patel K, Aké-Assi M, Le Coeur S, Chokephaibulkit K, Abrams E, Yotebieng M, Quartagno M, Crichton S, Jesson J, Vicari M, Seage G, Bekker L, Thorne C, Goetghebuer T, Wanless S, Kekitiinwa-Rukyalekere A, Mwita L, Lukhele B, Nyasulu P, Thahane L, Matshaba M, Williams P, Powis K, Slogrove A, Wools-Kaloustian K, Collins I, Penazzato M, Gibb D, Essajee S, Collaborative Initiative for Paediatric HIV Education and Research (CIPHER) Global Cohort Collaboration. Growth and CD4 patterns of adolescents living with perinatally acquired HIV worldwide, a CIPHER cohort collaboration analysis. J Int AIDS Soc 2022; 25:e25871.

Type

Journal Paper/Review (English)

Journal

J Int AIDS Soc 2022; 25

Publication Date

Mar 1, 2022

Issn Electronic

1758-2652

Pages

e25871

Brief description/objective

INTRODUCTION
Adolescents living with HIV are subject to multiple co-morbidities, including growth retardation and immunodeficiency. We describe growth and CD4 evolution during adolescence using data from the Collaborative Initiative for Paediatric HIV Education and Research (CIPHER) global project.

METHODS
Data were collected between 1994 and 2015 from 11 CIPHER networks worldwide. Adolescents with perinatally acquired HIV infection (APH) who initiated antiretroviral therapy (ART) before age 10 years, with at least one height or CD4 count measurement while aged 10-17 years, were included. Growth was measured using height-for-age Z-scores (HAZ, stunting if <-2 SD, WHO growth charts). Linear mixed-effects models were used to study the evolution of each outcome between ages 10 and 17. For growth, sex-specific models with fractional polynomials were used to model non-linear relationships for age at ART initiation, HAZ at age 10 and time, defined as current age from 10 to 17 years of age.

RESULTS
A total of 20,939 and 19,557 APH were included for the growth and CD4 analyses, respectively. Half were females, two-thirds lived in East and Southern Africa, and median age at ART initiation ranged from <3 years in North America and Europe to >7 years in sub-Saharan African regions. At age 10, stunting ranged from 6% in North America and Europe to 39% in the Asia-Pacific; 19% overall had CD4 counts <500 cells/mm . Across adolescence, higher HAZ was observed in females and among those in high-income countries. APH with stunting at age 10 and those with late ART initiation (after age 5) had the largest HAZ gains during adolescence, but these gains were insufficient to catch-up with non-stunted, early ART-treated adolescents. From age 10 to 16 years, mean CD4 counts declined from 768 to 607 cells/mm . This decline was observed across all regions, in males and females.

CONCLUSIONS
Growth patterns during adolescence differed substantially by sex and region, while CD4 patterns were similar, with an observed CD4 decline that needs further investigation. Early diagnosis and timely initiation of treatment in early childhood to prevent growth retardation and immunodeficiency are critical to improving APH growth and CD4 outcomes by the time they reach adulthood.