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

for the Italian Register for HIV Infection in Children, Elena Chiappini, Francesca Larotonda, Catiuscia Lisi, Vania Giacomet, Paola Erba, Stefania Bernardi, Paola Zangari, Antonio Di Biagio, Lucia Taramasso, Carlo Giaquinto, Osvalda Rampon, Clara Gabiano, Silvia Garazzino, Claudia Tagliabue, Susanna Esposito, Eugenia Bruzzese, Raffaele Badolato, Domenico Zanaboni, Monica CelliniMaurizio Dedoni, Antonio Mazza, Andrea Pession, Anna Maria Giannini, Filippo Salvini, Icilio Dodi, Ines Carloni, Salvatore Cazzato, Pier Angelo Tovo, Maurizio de Martino, Luisa Galli

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish
Article number665764
JournalFrontiers in Pediatrics
Volume9
DOIs
Publication statusPublished - Jul 16 2021

Keywords

  • aids
  • antiretroviral therapy (ART)
  • children
  • epidemiology
  • HIV
  • perinatal infection
  • survival

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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