RESUMO
Background: Adolescents living with perinatally-acquired HIV (APHIV) face challenges including HIV serostatus disclosure. We assessed their 24-month outcomes in relation to the disclosure of their own HIV serostatus. Methods: Nested within the International epidemiologic Database to Evaluate AIDS pediatric West African prospective cohort (IeDEA pWADA), the COHADO cohort included antiretroviral (ART)-treated APHIV aged 10-19 years, enrolled in HIV care before the age of 10 years, in Abidjan (Côte d'Ivoire) and Lomé (Togo) in 2015. We measured the HIV serostatus disclosure at baseline and after 24 months and analyzed its association with a favorable combined 24-month outcome using logistic regression. The 24-month combined clinical immuno-virological outcome was defined as unfavorable when either death, loss to follow-up, progression to WHO-AIDS stage, a decrease of CD4 count >10% compared to baseline, or a detectable viral load (VL > 50 copies/mL) occurred at 24 months. Results: Overall, 209 APHIV were included (51.6% = Abidjan, 54.5% = females). At inclusion, the median CD4 cell count was 521/mm 3 [IQR (281-757)]; 29.6% had a VL measurement, of whom, 3.2% were virologically suppressed. APHIV were younger in Lomé {median age: 12 years [interquartile range (IQR): 11-15]} compared to Abidjan [14 years (IQR: 12-15, p = 0.01)]. Full HIV-disclosure increased from 41.6% at inclusion to 74.1% after 24 months. After 24 months of follow-up, six (2.9%) died, eight (3.8%) were lost to follow-up, and four (1.9%) were transferred out. Overall, 73.7% did not progress to the WHO-AIDS stage, and 62.7% had a CD4 count above (±10%) of the baseline value (48.6% in Abidjan vs. 69.0% in Lomé, p < 0.001). Among the 83.7% with VL measurement, 48.8% were virologically suppressed (Abidjan: 45.4%, Lomé: 52.5%, p <0.01). The 24-month combined outcome was favorable for 45% (29.6% in Abidjan and 61.4% in Lomé, p < 0.01). Adjusted for baseline variables, the 24-month outcome was worse in Lomé in those who had been disclosed for >2 years compared to those who had not been disclosed to [aOR = 0.21, 95% CI (0.05-0.84), p = 0.03]. Conclusions: The frequency of HIV-disclosure improved over time and differed across countries but remained low among West African APHIV. Overall, the 24-month outcomes were poor. Disclosure before the study was a marker of a poor 24-month outcome in Lomé. Context-specific responses are urgently needed to improve adolescent care and reach the UNAIDS 90% target of virological success.
RESUMO
OBJECTIVE: Adolescents living with HIV are sexually active and engaged in risky sexual behaviors. Knowledge on how and to what extent adolescents in HIV care are affected by pregnancy is needed so as to adopt better preventive services. We estimated 4-year pregnancy incidence and correlates among HIV-infected female adolescents in HIV care in urban Côte d'Ivoire. DESIGN: We conducted retrospective analysis of a pediatric prospective cohort of the International epidemiological Databases to Evaluate AIDS (IeDEA) West Africa Collaboration. Female patients with confirmed HIV infection aged 10-19 years, having at least one clinical visit in 2009 to health facilities participating in the pediatric IeDEA West African cohort in Abidjan, Côte d'Ivoire, were included. Data on incident pregnancies were obtained through medical records and interviews with health professionals. Pregnancy incidence rate was estimated per 100 person-years (PY). Poisson regression models were used to identify factors associated with the first pregnancy and provided incidence rate ratios (IRR) with 95% confidence intervals (CI). RESULTS: In 2009, 266 female adolescents were included, with a median age of 12.8 years (interquartile range, IQR: 10.0-15.0), CD4 cell counts of 506 cells/mm(3) (IQR: 302-737), and 80% on antiretroviral treatment. At the 48th month, 17 new pregnancies were reported after 938 PY of follow-up: 13 girls had one pregnancy while 2 had two pregnancies. Overall incidence rate of pregnancy was 1.8/100 PY (95% CI: 1.1-2.9). High incidence was observed among those aged 15-19 years: 3.6/100 PY (95% CI: 2.2-5.9). Role of maternal death in the risk of pregnancy was at the limit of statistical significance (adjusted IRR: 3.1, 95% CI: 0.9-11.0; ref. non-maternal orphans). CONCLUSIONS: Incidence of pregnancy among HIV-infected adolescents in care aged 15-19 years reached a level observed in adult cohorts in Sub-Saharan Africa. Health personnel in pediatric care have to intensify their efforts to provide more realistic and age-adapted reproductive health services to meet the needs of adolescent patients already confronting issues of sexuality. Vulnerability of maternal orphans merits further investigation.