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The global epidemiology of perinatally HIV-infected adolescents PowerPoint Presentation

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Description : The global epidemiology of perinatally HIV-infected adolescents

Tags : Pediatrics, Child Health, pediatric practice, pediatrician, health providers, HIV-infected infants, Adolescent Transition, HIV-infected adolescents, epidemiology

Published on : Jul 16, 2020 | Views : 1509 | Downloads : 0

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Slide 1-

The global epidemiology of perinatally HIV-infected adolescents: a Collaborative Initiative for Paediatric HIV Education & Research (CIPHER) Global Cohort Collaboration analysis www.iasociety.org www.iasociety.org Amy Slogrove, Ali Judd, Valeriane Leroy for the CIPHER Global Cohort Collaboration Adolescent Project Team AIDS 2016, Durban, South Africa
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Background www.iasociety.org www.iasociety.org Global access to antiretroviral therapy (ART) is expanding Emerging population of perinatally HIV-infected adolescents (PHA) across all regions HIV-infected adolescents face barriers compared to adults Access to ART Remaining in care
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Objective & Definitions www.iasociety.org www.iasociety.org Primary Objective Describe the global epidemiology and geographic trends of characteristics and outcomes (mortality, transfer out, loss to follow-up) of PHA surviving beyond age 10 years Definitions PHA – entered care before age 10 years, with no known non-vertical route of HIV-infection and were followed beyond age 10 years Lost to follow-up (LTFU) – last visit >365 days prior to database closure; censored 365 days after last visit
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Methods www.iasociety.org www.iasociety.org CIPHER Global Cohort Collaboration Individual retrospective data from 12 cohort networks were pooled, representing 50 countries South America & Caribbean: CCASAnet North America: IMPAACT & PHACS Europe & Central Asia: EPPICC South & Southeast Asia: EPPICC, IeDEA - Asia-Pacific, MSF Sub-Saharan Africa: BIPAI, IeDEA - Central Africa, IeDEA - East Africa, IeDEA - Southern Africa, IeDEA - West Africa, MSF, Optimal Models (ICAP)
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Characteristics at first visit, ART start, age 10 years and last visit Cumulative incidence for outcomes calculated by competing risks analysis (mortality, transfer out, loss to follow-up) Mortality hazard ratios - Cox proportional hazards regression Unadjusted Adjusted Complete cases only Multiple imputation for missing CD4 and height measurements www.iasociety.org www.iasociety.org Methods
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South America & Caribbean 903 (2%) Female 53.8% North America 1 032 (3%) Female 50.1% Europe & Central Asia 3 054 (8%) Female 51.7% South & SE Asia 2 902 (8%) Female 50.1% Sub-Saharan Africa 30 296 (79%) Female 50.5% Perinatally HIV-infected Adolescents www.iasociety.org www.iasociety.org Total N = 38 187 Female 50.6%
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South America & Caribbean Year 1998 North America Year 1994 (1992; 1996) Europe & Central Asia Year 1995 (1991; 1999) South & SE Asia Year 2001 (1999; 2002) Sub-Saharan Africa Year 2000 Median (IQR) year of birth www.iasociety.org (1995; 2000) (1999; 2002) www.iasociety.org Total Year 2000 (1998; 2002)
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Age: Median (IQR) 6.7 (4.4; 8.4) 7.5 (5.2; 9.2) 12.4 (11.1; 14.4) Age in Years 0 www.iasociety.org First Visit Last Visit ART Start www.iasociety.org 5 10 15
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CD4 Percent: Median (IQR) 16% (9; 25) 28% (20; 34) 14% (8; 20) 28% (21; 35) CD4 percent (%) 10 0 20 30 40 www.iasociety.org First Visit ART Start Age 10 Years Last Visit www.iasociety.org
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CD4 Percent: Median (IQR) CD4 percent (%) 10 0 20 30 40 On ART 29% (21; 35) Not on ART 25% (19; 32) www.iasociety.org First Visit ART Start Age 10 Years Last Visit www.iasociety.org
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Proportion on ART 88% (33 514) Ever received ART 8% (3 091) 67% (26 953) 80% (30 072) First Visit Age 10 Years Last Visit % on ART 70 60 50 40 30 10 0 20 80 90 www.iasociety.org www.iasociety.org
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Virologic Suppression 75% (6 627/8 825) 72% (9 388/13 114) Age 10 Years Last Visit % Suppressed 70 60 50 40 30 20 10 0 80 HIV viral load available in 39% of adolescents on ART www.iasociety.org www.iasociety.org
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WHO Height-for-Age Z-score (HAZ) Median (IQR) HAZ First Visit ART Start Age 10 years Last Visit 0 1 -1 -2 -3 -1.92 (-2.91; -0.97) -1.95 (-2.91; -1.02) -1.53 (-2.35; -0.72) -1.59 (-2.45; -0.72) www.iasociety.org www.iasociety.org
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WHO Height-for-Age Z-score (HAZ) Median (IQR) HAZ First Visit ART Start Age 10 years Last Visit 0 1 -1 -2 -3 -1.59 (-2.45; -0.72) On ART -1.58 (-2.43; -0.72) Not on ART -1.62 (-2.50; -0.72) www.iasociety.org www.iasociety.org
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Outcomes: Total Cohort Time in years from age 10 Cumulative Incidence Function Transferred out 15.6% (95% CI 15.1; 16.0) LTFU 11.3% (95% CI 10.9; 11.8) Mortality 2.6% (95% CI 2.4; 2.8%) www.iasociety.org www.iasociety.org
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Outcomes: by Region Time in years from age 10 Cumulative Incidence Function All PHA South America & Caribbean North America Europe Sub-Saharan Africa South & Southeast Asia Transferred Out LTFU Mortality www.iasociety.org www.iasociety.org
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Mortality Hazard Ratios www.iasociety.org www.iasociety.org
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Mortality Hazard Ratios www.iasociety.org www.iasociety.org * Adjusted for gender, calendar period of birth, age at first visit, CD4% at first visit, HAZ at first visit
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Discussion www.iasociety.org www.iasociety.org Survivor cohort that beat the odds Limited to PHA that presented before 10 years of age At first visit and ART start, age & CD4% differed substantially by region By 10 years and at last visit, CD4% , proportion on ART and proportion virologically suppressed were similar across regions Height growth remained severely impaired in most regions even in those receiving ART Observed mortality < 3% during adolescence in PHA surviving to 10 years of age should be considered as a conservative estimate Mortality during adolescence is substantially elevated for perinatally HIV-infected adolescents in South America & Africa relative to Europe
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Adolescent Project Team www.iasociety.org www.iasociety.org Co-chairs: Ali Judd (EPPICC) and Valeriane Leroy (IeDEA-West-Africa) Data center: Mary-Ann Davies, Michael Schomaker, Amy Slogrove Data managers: Sebastian Wanless, Charlotte Duff Members: BIPAI (Baylor): Nancy Calles CCASAnet: Jorge Pinto EPPICC: Josiane Warszawski IeDEA Asia-Pacific: Kulkanya Chokephaibulkit IeDEA Central Africa: Marcel Yotebieng IeDEA East Africa: Kara Wools-Kaloustian IeDEA Southern Africa: Nicky Maxwell IeDEA West-Africa: François Eboua IMPAACT: Paige Williams MSF: Jihane Ben-Farhat Optimal Models (ICAP): Chloe Teasdale PHACS: George Seage
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Acknowledgements www.iasociety.org www.iasociety.org International AIDS Society CIPHER Steering Committee CIPHER Global Cohort Collaboration Oversight Group Marissa Vicari – Manager, CIPHER UCT CIDER Data Centre Mary-Ann Davies, Michael Schomaker, Dolphina Cogill, Nicky Maxwell Networks BIPAI, CCASAnet, EPPICC, IeDEA-Asia-Pacific, IeDEA-Central Africa, IeDEA-East Africa, IeDEA-Southern Africa, IeDEA-West Africa, IMPAACT, MSF, PHACS, Optimal Models
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www.iasociety.org www.iasociety.org
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LTFU-Mortality Scenarios Original HR estimate 100% of all LTFU is mortality 50% of all LTFU is mortality 20% of all LTFU is mortality Reference = Europe A B C D 1 0 5 10 www.iasociety.org www.iasociety.org
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Original HR estimate Reference = Europe A B C D 5% of LTFU in Africa & 20% of LTFU rest 20% of LTFU in Africa & 5% of LTFU rest 50% of LTFU in Africa & 5% of LTFU rest LTFU-Mortality Scenarios 1 0 5 10 www.iasociety.org www.iasociety.org
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Mortality Hazard Ratios www.iasociety.org www.iasociety.org * Adjusted for gender, calendar period of birth, age at first visit, CD4% at first visit, HAZ at first visit
Slide 26-

Mortality Hazard Ratios www.iasociety.org www.iasociety.org * Adjusted for gender, calendar period of birth, age at first visit, CD4% at first visit, HAZ at first visit

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