complications of hiv in perinatally infected adolescents and young adults in resource-poor settings...
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![Page 1: Complications of HIV in perinatally infected adolescents and young adults in resource-poor settings Philippa Musoke MBChB PhD Department of Paediatrics](https://reader035.vdocument.in/reader035/viewer/2022062517/56649eeb5503460f94bfcba6/html5/thumbnails/1.jpg)
Complications of HIV in perinatally infected adolescents and young adults
in resource-poor settings
Philippa Musoke MBChB PhDDepartment of Paediatrics and Child HealthCollege of Health Sciences, School of MedicineMakerere UnversityKampala UgandaandMUJHU Research Collaboration
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Outline
Complications of HIV infection in adolescentso Malnutrition
o Chronic lung disease
o Tuberculosis
o Lipodystrophy
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Malnutrition and HIV infection Most HIV infected children are malnourished
Median wt- and ht-for-age z-score <-2 In 30 different studies of children on ART (Sutclife)
30 – 50% of children hospitalized with severe acute malnutrition (SAM) are HIV+ (Bachou H)
Mortality of children with HIV and SAM is 4 times higher than those with SAM alone (30% vs 8%) (Fergusson P)
Severe pneumonia and SAM were risk factors for death in hospitalized children (Preidis GA J Pediatr 2011)
Fergusson P, et al Trans R Soc Trop Med Hyg 2008; Sutcliffe et al CG , Bachou H et al. Nutr J 2006,
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Adolescents physical changes
Stunted and wasted
Dermatological changes
Puberty delayed
Complications from ART
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STUNTING in HIV infected sibling
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Severe malnutrition post ART ARROW trial – Compared children who were hospitalized
with SAM ( both edematous and non-edematous types) and those not hospitalized
39/1207 (3.2%) were hospitalized (20 with edema) Median days after ART initiation = 27 days
Age median 6 years (3-17 years)
Children with advanced disease n =220 (CD4% & WAZ<-3 SD) 7.3% (95% CI 3.8–10.7) kwashiorkor (K) 3.2 % (95% CI 1.2–6.1) marasmus (M)
Mortality at 24 wks - 32% marasmus; 20% kwashiorkor - compared to 1.7 % for non hospitalized children
Prendergast A et al AIDS 2011
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Chronic Lung disease in adolescents
HIV infected ART naïve adolescents N=116 (Zimbabwe) Mean Age: 14 years + 2.6 years 43% male Chronic cough 66% >40% had hypoxia at rest Pathology: small airway disease associated
with bronchiectasis
Ferrand RA et al CID 2011
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Increase incidence of Tuberculosis disease in HIV infected
children Cohort of south African children randomized to INH or
placebo(548 HIV+ and 804 HIV- infants) (Smith) 121 TB cases /1000 child-years (CI 95-153) HIV+
41 TB cases/1000 child-years (CI 31-52) HIV – No benefit of INH prophylaxis
IRIS (20-30% of children on ART) 29% of IRIS events in children were TB –Uganda
(Orikiriiza)
71% % of IRIS events in children were TB –S.Africa (Mahdi) Majority BCG adenitis
Mahdi SA et al NEJM 2011; Orikiriiza J et al AIDS 2009; Smith K et al AIDS 2009
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Prevalence of Immune Reconstitution Syndrome
Cohort of 162 Ugandan children on ART 38% ( CI 31-36) developed IRIS Median Age 6 years (IQR 2.5-12 years) Tuberculosis was the most common event=29% Others - pruritic papular eruptions (PPE) , candida
and pneumonia
Factors associated with IRIS Male sex OR 2.96 (1.30-6.74) Pre-ART CD4% OR 4.39 (1.62-11.08) CD8+ < 1000 cells/ul OR 4.56 (2.01-10.34) Cough(current) OR 4.30 (1.84-10.08)
Orikiriiza J et al AIDS 2010
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Lipodystrophy in Resource-Limited Settings
Thailand 90 HIV+ children on ART (NNRTI) Lipodystrophy – 9%, 47% and 65% at 48, 96 and 144 weeks 11% dyslipidemia
India 52 HIV + children ( 25 ART – non PI, 27 not on ART) Only 4 had cholesterol 2 lipoatrophy, 3 triglycerides ( follow up 3 months)
Brazil 30 children (30% on PI) median duration on ART 28 mths 53% lipodystrophy, 60% dyslipidemia
Aurpibul L et al Antivir Ther 2007; Parakh A Indian J Pediatr; Sarni RO et al J Pediatr
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Lipodystrophy on ART
364 children enrolled in a cross sectional study, Uganda Median age was 8 years ( range 2-18) Prevalence of fat redistribution was 27%
Only 29% of them also had hyperlipidaemia Prevalence of hyperlipidemia was 34%
Factors associated with fat redistribution
Tanner stage >2, age > 5yrs and use of d4T regimen
J Int AIDS Soc. 2012
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