Perinatally HIV-infected adolescents care. Ten years of experience in a public hospital in Buenos Aires, Argentina
C. Rodriguez1, S. Arazi2, J. Yañez Garcia1, E. Cordova1, R. Bologna2
1Hospital `Cosme Argerich´, Infectious Diseases Department, Buenos Aires, Argentina, 2Hospital de Pediatria J.P.Garrahan, Infectious Diseases and Epidemiology Department, Buenos Aires, Argentina
Background: An increasing number of perinatally HIV-infected patients are reaching adolescence and began the transition to adult HIV-care. Few data of this heterogeneous population is available. The aim of this study was to describe clinical and epidemiological findings of a cohort of adolescents HIV-infected patients.
Methods: Retrospective descriptive study of perinatally HIV-infected adolescents assisted at the adult HIV-care, “Cosme Argerich” Hospital, Buenos Aires, Argentina (2000-2009).
Results: Of a total of 74 adolescent patients, 37 (50%) were infected perinatally. Median age at transition: 16 years (IC95% 14.89 to 17.01). Male sex: 17/37 (46%) (IC95% 31-62). Only 1/37 (3%) had both parents alive and 21/37 (57%) were orphans. History of opportunistic or HIV-related infections: 13/35 (37%) (IC95% 23-53). Age at HIV-diagnosis disclosure (median): 12 years (range 10-16). At the time of the transition: CD4 T-cell count (median): 438 cells/mm3 (IC95% 349-569), none of the patients had CV< 50 copies/ml. Number of previous regimens (median): 4 (IC95% 3.2-4.5). Currently antiretroviral therapy (ART): 35/37 (95%). Median of follow up: 8 years (IC95% 5.90-9.45). Darunavir, raltegravir, enfuvirtide or etravirine regimens: 16%. Currently viral load < 50 copies/ml: 18/35 (51%) (IC95% 36-67). Last CD4 T-cell count (median): 448 cells/mm3 (IC95% 391-916); 22.5% (IC95% 18.6-30); CD4 T-cell count < 200 cells/ml: 2/34 (6%) (IC95% 1-20). Visits during last year (median): 3 (range 2-5). Good adherence to ART: 21/33 (64%) (IC95% 47-78). Fifteen percent had severe lipodystrophy. Alcohol abuse and illicit drugs consumption was observed in 8/35 (23%) and 2/35 (6%) respectively. Education according to age: 24/34 (71%). Pregnancy: 9/20 (45%).
Conclusions: Perinatally HIV-infected adolescents are a challenge to adults HIV-care due to a heavy ART history and complex psychosocial context. To maximize the likelihood of a successful transition a “teen-centered” and multidisciplinary care is necessary.
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