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Older children and adolescents surviving with vertically acquired HIV infection
Claire Thorne1, Marie-Louise Newell, Francesc Asensi Botet
1Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, London, UK
Insights
Children with vertically acquired HIV infection who survive past 10 years generally remain asymptomatic. These pediatric HIV survivors require tailored adolescent services, including psychosocial support and sexual health education.
Area of Science:
- Pediatric Infectious Diseases
- HIV/AIDS Research
- Adolescent Health
Background:
- Vertical HIV transmission presents long-term health challenges for infected children.
- Understanding the characteristics of long-term survivors is crucial for optimizing care.
- The European Collaborative Study provides a prospective cohort for longitudinal analysis.
Purpose of the Study:
- To describe the clinical, immunologic, virologic, therapeutic, and psychosocial profiles of children with vertically acquired HIV infection surviving 10 years or more.
- To identify factors associated with long-term survival and well-being in this cohort.
- To inform the development of age-appropriate services for adolescents living with HIV.
Main Methods:
- Prospective cohort study of vertically HIV-infected children within the European Collaborative Study.
- Analysis of clinical status, immunologic markers, viral load, antiretroviral therapy regimens, and psychosocial factors.
- Assessment of disease progression using U.S. Centers for Disease Control and Prevention (CDC) classification.
Main Results:
- Of 187 infected children, 34 survived 10+ years (median age 11.4 years).
- Most children remained asymptomatic or had mild disease (CDC Class A/B), with good immune status (CDC categories 1 or 2).
- Combination antiretroviral therapy was common; psychosocial factors included parental survival and disclosure of HIV status.
Conclusions:
- Vertically HIV-infected children surviving the first decade are largely asymptomatic and maintain good immune function.
- Adolescents living with HIV require specialized services, including support for disclosure, mental health, and sexual health.
- Long-term management strategies must address the evolving needs of this growing population.
Abstract:
This article describes the characteristics of children infected vertically with HIV surviving 10 years or more who were enrolled in the prospective European Collaborative Study. Thirty-four of 187 infected children were identified with a median age of 11.4 years (range, 10.1-15.9 years). Factors examined included clinical status, immunologic and virologic characteristics, type of antiretroviral therapy, and psychosocial characteristics. By 10 years of age, 6 (18%) children had progressed to Class A as determined by the system of the U.S. Centers for Disease Control and Prevention (CDC), 17 (52%) to class B, 7 (21%) to class C, and 3 (9%) had remained asymptomatic. At 73% (904 of 1234) of scheduled clinic visits, these children had no symptoms of HIV disease. Most children were in CDC immune categories 1 (18, 56%) or 2 (11, 34%) at their last visit. Three quarters (24 patients) were on combination therapy with three or more drugs, although 3 children had never received any antiretroviral therapy. Nineteen (56%) children were living with at least 1 parent and the mothers of 13 (38%) children had died. Most (77%) children had been told about their HIV infection. Children infected vertically with HIV who have survived their first 10 years are mainly free of serious symptoms. As they enter adolescence, additional services are needed including support with disclosure to others, therapy, and sexual health.