'Encouraging' long-term outcomes for French children infected with HIV at birth

Michael Carter
Published: 29 June 2010

The outcomes for children who were infected with HIV at birth before 1993 in France are “encouraging”, investigators report in the July 15th edition of Clinical Infectious Diseases.

Sixty percent were still alive by 2009, and the surviving patients had a median CD4 cell count of above 500 cells/mm3. School achievement, height, weight, and growth were comparable to those seen in age-matched French school children.

Improvements in antiretroviral therapy mean that children infected with HIV at birth are increasingly likely to survive into adolescence and adulthood.

However, little is known about the current health status of these children, or their wider social circumstances.

Investigators from the French Perinatal Cohort therefore analysed outcomes for 348 children who were infected with HIV at birth between 1985 and 1993.

A total of 47 infants (14%) died before their second birthday, with a further 58 (17%) subsequently dying, and 33 (10%) were lost to follow-up.

Most of the deaths occurred before effective HIV treatment first became available in 1996.

The 210 children who were still in follow-up had a median age of 15 years, 50% were boys, and 30% had mothers who were born in sub-Saharan Africa.

Most of the children (82%) were living with family members, with approximately two-thirds (65%) living with one or both parents.

For 54%, the mother was still alive, but 12% lived with other guardians even when the mother was living.

Information on schooling was available for 179 children: 84% were in general schooling. However, 27 (15%) had repeated two or more grades, and 2% had dropped out of education. Vocational training was being pursued by 13% of the children, and 3% required special education. The investigators note that this pattern of educational attainment is comparable to that seen in the general French school population.

Most (77%) of the children were taking potent, multi-drug antiretroviral therapy. But 16% had stopped taking such treatment, the main reason being difficulties with adherence.

The median CD4 cell count was 557 cells/mm3, and 94% of the young people had a CD4 cell count above 200 cells/mm3.

Median viral load was 200 copies/ml, and was undetectable in only 43% of individuals. This increased slightly (55%) when analysis was restricted to those taking effective HIV treatment.

Height, weight, body mass index, and growth were all in line with national averages.

“The current health status of perinatally infected children followed from birth to adolescence … is encouraging, particularly given the limited therapeutic options available during the first few years of these individuals’ lives and the specific issues associated with treatment adherence in adolescents with chronic diseases,” conclude the investigators.

Reference

Dollfus C et al. Long-term outcomes in adolescents perinatally infected with HIV-1 and followed up since birth in the French Perinatal Cohort (EPF/ARNS CO10). Clin Infect Dis 51: 214-24, 2010.