Abstract
There is a paucity of knowledge about perinatally infected human immunodeficiency
virus (HIV) positive children surviving into their adolescent years, especially from
sub-Saharan Africa. Although studies have described the effects of the disease on
the physical and sexual maturation of this population, their response to highly active
antiretroviral therapy has not been systematically studied. At the pediatric infectious
diseases clinic in Mulago hospital, Kampala, Uganda, we evaluated the effect of antiretroviral
therapy (ART) on 118 treatment-naive, perinatally-infected HIV positive adolescents
between the ages of 10–19 for 12 months. We monitored physical growth using The Centers
for Disease Control and Prevention and recently published World Health Organization
(WHO) reference growth standards for height and weight measurements as well as sexual
maturation using Tanner staging. Laboratory tests including: complete blood count,
absolute CD4 cell count and percentage, and HIV-1 RNA viral load, were performed at
baseline and at 3-month intervals. Of 118 children, 64% were female; the median age
was 13.6 years old. At baseline, 75% were classified as WHO clinical stages III and
IV, with a median CD4 count of 124 cells/ul. Apart from four adolescents, all were
on first-line antiretroviral therapy with 2 nucleoside reverse transcriptase inhibitors
and 1 non-nucleoside reverse transcriptase inhibitors. After 6 months, the median
CD4 count was 304 cells/μL, increasing to 370 cells/μL, by 12 months. Antiretroviral
therapy was virologically suppressive (HIV-1 RNA viral load <400 copies/mL) in 79%
of the adolescents at 6 months and in 89% at 12 months. Six (5%) patients died during
the 12-month study. The median baseline height for age Z score was −2.41 which improved
to a median of −1.96 by 12 months (P < 0.0001). The median baseline weight for age Z score was −2.61 and improved to −1.26
by 12 months (P < 0.0001). The median body mass index Z score increased from −1.39 to −0.47 by 12
months (P < 0.0001). At baseline, 63% of the adolescents were noted to have delayed pubertal
maturation; this only reduced slightly to 60% after 12 months. Adolescents with predominantly
perinatally-acquired HIV infection and significant disease burden showed appropriate
virologic and immunological response to ART in addition to having clinically significant
improvements in growth and some improvement in sexual maturation.
Keywords
Adolescents - HIV - Africa - antiretroviral therapy
