Outcomes and challenges in adolescents with HIV in France: a nationwide cohort study over 35 years

Most data published on adolescents with HIV (AWH) have been collected before the large diffusion of second-generation integrase strand transfer inhibitors (INSTI) among the pediatric population. We analyzed the nationwide ANRS-MIE CO10 Pediatric cohort to assess the changes over time in health and social outcomes of French AWH.

The cohort enrolled children born in France since 1985 and, from 2005, children diagnosed with HIV at ≤13 years, including those born abroad if antiretroviral-naive at first medical care in France.

Adolescents aged ≥10 years at their last visit were included in this analysis. Their characteristics were compared between three periods of birth (1985-1993, 1994-1999, 2000-2010).

Overall, 529 AWH were included. Their median age at first HAART initiation decreased from 94 to 29 months ( P  < 0.0001). At the last evaluation, the proportions of AWH receiving HAART, receiving INSTI, having HIV-RNA < 50 copies/mL and having CD4 count ≥500/μl increased over time ( P  < 0.0001), reaching 98·7%, 53.3%, 81.3% and 85·0%, respectively, for those born in 2000-2010. The proportion of maternal and paternal orphans decreased until 14.4% and 11.0%, respectively, for AWH born recently. Compared to middle adolescents (15-17 years) born in 1994-1999, those born in 2000-2010 demonstrated higher academic success (69·2% versus 42·3%) and less frequent academic failure (4.6% versus 6.2%).

Despite spectacular improvement in their health and immunovirological status, AWH remain vulnerable compared to other French adolescents, with a higher risk of being orphan and/or experiencing academic failure. Specific interventions are required to improve their global quality of life.