24-Month Clinical, Immuno-Virological Outcomes, and HIV Status Disclosure in Adolescents Living With Perinatally-Acquired HIV in the IeDEA-COHADO Cohort in Togo and Côte d'Ivoire, 2015–2017

Frontiers in Pediatrics

article

Marc Harris Dassi Tchoupa Revegue¹  Hortense Aka-Dago-Akribi²  Jean-Philippe Raynaud¹  Elise Arrivé⁴  Valériane Leroy¹  Unoo Elom Takassi⁵  François Tanoh Eboua⁶  Sophie Desmonde¹  Ursula Belinda Amoussou-Bouah⁶  Tchaa Abalo Bakai⁵  Julie Jesson¹  Désiré Lucien Dahourou⁷  Karen Malateste⁴ 

[1] Center for Epidemiology and Research in POPulation Health (CERPOP), Université de Toulouse, Université Paul Sabatier;Département de Psychologie Clinique, Université Houphouet-Boigny;Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent;Université de Bordeaux;Department of Pediatrics, Centre Hospitalier Universitaire Sylvanus Olympio;Department of Pediatrics, Centre Hospitalier Universitaire de Yopougon;Département Biomédical et de Santé Publique, Institut de Recherche en Sciences de la Santé (IRSS/CNRST);Centre Muraz

关键词: adolescents;    HIV;    disclosure;    retention;    West-Africa;   

DOI  :  10.3389/fped.2021.582883

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Background: Adolescents living with perinatally-acquired HIV (APHIV) face challenges including HIV serostatus disclosure. We assessed their 24-month outcomes in relation to the disclosure of their own HIV serostatus. Methods: Nested within the International epidemiologic Database to Evaluate AIDS pediatric West African prospective cohort (IeDEA pWADA), the COHADO cohort included antiretroviral (ART)-treated APHIV aged 10–19 years, enrolled in HIV care before the age of 10 years, in Abidjan (Côte d'Ivoire) and Lomé (Togo) in 2015. We measured the HIV serostatus disclosure at baseline and after 24 months and analyzed its association with a favorable combined 24-month outcome using logistic regression. The 24-month combined clinical immuno-virological outcome was defined as unfavorable when either death, loss to follow-up, progression to WHO-AIDS stage, a decrease of CD4 count >10% compared to baseline, or a detectable viral load (VL > 50 copies/mL) occurred at 24 months. Results: Overall, 209 APHIV were included (51.6% = Abidjan, 54.5% = females). At inclusion, the median CD4 cell count was 521/mm 3 [IQR (281–757)]; 29.6% had a VL measurement, of whom, 3.2% were virologically suppressed. APHIV were younger in Lomé {median age: 12 years [interquartile range (IQR): 11–15]} compared to Abidjan [14 years (IQR: 12–15, p = 0.01)]. Full HIV-disclosure increased from 41.6% at inclusion to 74.1% after 24 months. After 24 months of follow-up, six (2.9%) died, eight (3.8%) were lost to follow-up, and four (1.9%) were transferred out. Overall, 73.7% did not progress to the WHO-AIDS stage, and 62.7% had a CD4 count above (±10%) of the baseline value (48.6% in Abidjan vs. 69.0% in Lomé, p 2 years compared to those who had not been disclosed to [aOR = 0.21, 95% CI (0.05–0.84), p = 0.03]. Conclusions: The frequency of HIV-disclosure improved over time and differed across countries but remained low among West African APHIV. Overall, the 24-month outcomes were poor. Disclosure before the study was a marker of a poor 24-month outcome in Lomé. Context-specific responses are urgently needed to improve adolescent care and reach the UNAIDS 90% target of virological success.

【 授权许可】

CC BY