Full Text Available
Note: Clicking the button above will open the full text document at the original institutional repository in a new window.
Treatment outcomes in perinatally-infected HIV positive adolescents and young adults after 10+ years on antiretroviral therapy
There are currently more than 30 0 000 children under the age of 15 living with HIV in South Africa (SA). Due to a combination of recent success in preventing new vertical infections and success of paediatric antiretroviral treatment (ART) programmes in improving life-expectancy in perinatally HIV-i...
Saved in:
| Main Author: | |
|---|---|
| Other Authors: | |
| Format: | Thesis |
| Language: | English |
| Published: |
Department of Public Health and Family Medicine
2019
|
| Subjects: | |
| Tags: |
No Tags, Be the first to tag this record!
|
| _version_ | 1867613172406419456 |
|---|---|
| access_status_str | Open Access |
| author | Anderson, Kim |
| author2 | Davies, Mary-Ann |
| author_browse | Anderson, Kim Davies, Mary-Ann |
| author_facet | Davies, Mary-Ann Anderson, Kim |
| author_sort | Anderson, Kim |
| collection | Thesis |
| description | There are currently more than 30 0 000 children under the age of 15 living with HIV in South Africa (SA). Due to a combination of recent success in preventing new vertical infections and success of paediatric antiretroviral treatment (ART) programmes in improving life-expectancy in perinatally HIV-infected (PHIV) children, the burden of paediatric HIV in SA has changed to older children. An increasing population of PHIV children on ART is reaching adolescence, yet information on long-term treatment outcomes in this group is lacking. There is very limited published data on treatment outcomes in PHIV children after ≥10 years on ART in high income countries (HIC), and none in low- and middle-income countries (LMIC). We conducted a retrospective cohort study of PHIV adolescents on ART for ≥ 10 years at a single ART facility. The main objective of the study was to describe long-term clinical, growth, immunologic and virologic outcomes in the cohort. Part A, the protocol, as submitted for departmental and ethical approval, details the purpose and methodology of the study. Part B, the literature review, discusses what is known about long-term treatment outcomes in PHIV children on ART to date. It compares findings between HIC and LMIC. Long-term growth, immunologic and virologic outcomes, as well as factors associated with viral failure are described. The paucity of long-term data is demonstrated, indicating the need for further research on the topic. Part C, the journal-ready manuscript, details the methodology, results and interpretation of the longitudinal analysis of long-term treatment outcomes among 127 PHIV-infected adolescents and young adults on ART for ≥10 years. After median follow-up of 12 years since ART initiation, 80% of the cohort were virally suppressed and 79% had optimal immunologic status (CD4 >500 cells/μl). These results are favourable overall, but >40% of adolescents were on 2nd-line ART with poorer immunologic outcomes than those on 1st-line ART, and approximately one in three children experienced viral failure during adolescence. This highlights the vulnerability of this group, which requires careful further management. Appendices include all supporting documentation necessary for the above parts of the mini-dissertation. |
| format | Thesis |
| id | oai:open.uct.ac.za:11427/29183 |
| institution | University of Cape Town (South Africa) |
| language | eng |
| last_indexed | 2026-06-10T12:31:54.917Z |
| license_str | Not specified — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository |
| publishDate | 2019 |
| publishDateRange | 2019 |
| publishDateSort | 2019 |
| publisher | Department of Public Health and Family Medicine |
| publisherStr | Department of Public Health and Family Medicine |
| record_format | dspace |
| source_str | UCTD — University of Cape Town Open Access Repository |
| spelling | oai:open.uct.ac.za:11427/29183 Treatment outcomes in perinatally-infected HIV positive adolescents and young adults after 10+ years on antiretroviral therapy Anderson, Kim Davies, Mary-Ann Muloiwa, Rudzani paediatric antiretroviral treatment There are currently more than 30 0 000 children under the age of 15 living with HIV in South Africa (SA). Due to a combination of recent success in preventing new vertical infections and success of paediatric antiretroviral treatment (ART) programmes in improving life-expectancy in perinatally HIV-infected (PHIV) children, the burden of paediatric HIV in SA has changed to older children. An increasing population of PHIV children on ART is reaching adolescence, yet information on long-term treatment outcomes in this group is lacking. There is very limited published data on treatment outcomes in PHIV children after ≥10 years on ART in high income countries (HIC), and none in low- and middle-income countries (LMIC). We conducted a retrospective cohort study of PHIV adolescents on ART for ≥ 10 years at a single ART facility. The main objective of the study was to describe long-term clinical, growth, immunologic and virologic outcomes in the cohort. Part A, the protocol, as submitted for departmental and ethical approval, details the purpose and methodology of the study. Part B, the literature review, discusses what is known about long-term treatment outcomes in PHIV children on ART to date. It compares findings between HIC and LMIC. Long-term growth, immunologic and virologic outcomes, as well as factors associated with viral failure are described. The paucity of long-term data is demonstrated, indicating the need for further research on the topic. Part C, the journal-ready manuscript, details the methodology, results and interpretation of the longitudinal analysis of long-term treatment outcomes among 127 PHIV-infected adolescents and young adults on ART for ≥10 years. After median follow-up of 12 years since ART initiation, 80% of the cohort were virally suppressed and 79% had optimal immunologic status (CD4 >500 cells/μl). These results are favourable overall, but >40% of adolescents were on 2nd-line ART with poorer immunologic outcomes than those on 1st-line ART, and approximately one in three children experienced viral failure during adolescence. This highlights the vulnerability of this group, which requires careful further management. Appendices include all supporting documentation necessary for the above parts of the mini-dissertation. 2019-01-30T15:25:25Z 2019-01-30T15:25:25Z 2018 2019-01-30T15:24:35Z Master Thesis Masters MPH http://hdl.handle.net/11427/29183 eng application/pdf Department of Public Health and Family Medicine Faculty of Health Sciences University of Cape Town |
| spellingShingle | paediatric antiretroviral treatment Anderson, Kim Treatment outcomes in perinatally-infected HIV positive adolescents and young adults after 10+ years on antiretroviral therapy |
| thesis_degree_str | Master's |
| title | Treatment outcomes in perinatally-infected HIV positive adolescents and young adults after 10+ years on antiretroviral therapy |
| title_full | Treatment outcomes in perinatally-infected HIV positive adolescents and young adults after 10+ years on antiretroviral therapy |
| title_fullStr | Treatment outcomes in perinatally-infected HIV positive adolescents and young adults after 10+ years on antiretroviral therapy |
| title_full_unstemmed | Treatment outcomes in perinatally-infected HIV positive adolescents and young adults after 10+ years on antiretroviral therapy |
| title_short | Treatment outcomes in perinatally-infected HIV positive adolescents and young adults after 10+ years on antiretroviral therapy |
| title_sort | treatment outcomes in perinatally infected hiv positive adolescents and young adults after 10 years on antiretroviral therapy |
| topic | paediatric antiretroviral treatment |
| url | http://hdl.handle.net/11427/29183 |
| work_keys_str_mv | AT andersonkim treatmentoutcomesinperinatallyinfectedhivpositiveadolescentsandyoungadultsafter10yearsonantiretroviraltherapy |