Real-World Analysis of Survival and Clinical Events in a Cohort of Italian Perinatally HIV-1 Infected Children From 2001 to 2018

Frontiers in Pediatrics

article

Elena Chiappini¹  Carlo Giaquinto³  Osvalda Rampon³  Clara Gabiano⁴  Silvia Garazzino⁴  Claudia Tagliabue⁵  Susanna Esposito⁶  Eugenia Bruzzese⁷  Raffaele Badolato⁸  Domenico Zanaboni⁹  Monica Cellini^1,10  Francesca Larotonda¹  Maurizio Dedoni^1,11  Antonio Mazza^1,12  Andrea Pession^1,13  Anna Maria Giannini^1,14  Filippo Salvini^1,15  Icilio Dodi^1,16  Ines Carloni^1,17  Salvatore Cazzato^1,17  Pier Angelo Tovo⁴  Maurizio de Martino¹  Catiuscia Lisi¹  Luisa Galli¹  Vania Giacomet^1,18  Paola Erba^1,18  Stefania Bernardi^1,19  Paola Zangari^2,20  Antonio Di Biagio^2,21  Lucia Taramasso^2,21 

[1] Paediatric Infectious Diseases Unit, Department of Health Sciences, Anna Meyer Children's Hospital, University of Florence;Department of Paediatric Medicine, Anna Meyer Children's Hospital, University of Florence;Department of Women and Child Health, University of Padova;Paediatric Infectious Diseases Unit, Regina Margherita Children's Hospital, University of Turin;Paediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Istituti di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico Foundation, University of Milan;Paediatric Department, Pietro Barilla Children's Hospital, University of Parma;Paediatric Unit, Department of Translational Medical Sciences, University of Naples Federico II;Department of Clinical and Experimental Sciences, University of Brescia;Department on Internal Medicine and Therapeutics, Istituti di Ricovero e Cura a Carattere Scientifico Policlinico “S. Matteo” Foundation, University of Pavia;Paediatric Hemato-Oncology Unit, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia;Department of Paediatrics, Ospedale Microcitemico;Department of Paediatrics, “S. Chiara” Hospital;Paediatric Unit, IRCCS Scientific Institute for Research and Healthcare, Sant'Orsola Hospital;Paediatric Infectious Diseases Unit, University Hospital Policlinico Giovanni XXIII;Department of Paediatrics, Niguarda Hospital, University of Milan;Department of Medicine and Surgery, Pietro Barilla Children's Hospital, University of Parma;Department of Mother and Child Health, Salesi Children's Hospital;Paediatric Infectious Diseases Unit, Department of Paediatrics, Luigi Sacco Hospital, University of Milan;Unit of Immune and Infectious Diseases, Stefania Bernardi Academic Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital;Research Unit of Clinical Immunology and Vaccinology, Paola Zangari Academic Department of Pediatrics (DPUO), Bambino Gesù Children's Hospital;Infectious Diseases Unit, Policlinico San Martino Hospital, University of Genova

关键词: HIV;    perinatal infection;    children;    antiretroviral therapy (ART);    aids;    survival;    epidemiology;   

DOI  :  10.3389/fped.2021.665764

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Background: Combined antiretroviral therapy (cART) has been associated with a steep decrease in mortality and morbidity in HIV-1 infected children. New antiretroviral molecules and drug classes have been developed and the management of HIV-infected children has improved, but recent data on survival are limited. Methods: An observational retrospective study investigating changes in mortality and morbidity was conducted on 1,091 perinatally HIV-1 infected children enrolled in the Italian Register for HIV Infection in Children and followed-up from 2001 to 2018. Results: Three hundred and fifty-four (32%) AIDS events and 26 (2%) deaths occurred overtime. Mortality rates decreased from 0.4/100 person-years in 2001–2006 to 0.27/100 person-years in 2007–2012 and 0.07/100 person-years in 2013–2018. Notably, 92% of the dead children were born in Italy, but only 50% were followed-up since birth or within three months of age. Seventy three percent of children had started cART at age ≥6 months; 23% were treated for <30 days before death. B and C clinical events progressively decreased ( P < 0.0001). Opportunistic infections significantly decreased over time, but still were the most common events in all the periods (6.76/100 person-years in 2013–2018). In the last period, severe bacterial infections were the most common ones. Cancer rates were 0.07/100; 0.17/100; 0.07/100 person-years in the three periods, respectively. Conclusions: Progressive reductions both in mortality and in rates of class B and C clinical events and OIs have been observed during the cART era. However, deaths were still registered; more than half of dead children were enrolled after birth and had belatedly started cART.

【 授权许可】

CC BY