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Session 132 Poster Abstracts
Adolescents and HIV
Thursday, 1:30 - 3:30 pm
Hall B


763    
Clinical Profile of HIV-infected Adolescents in Latin America: Preliminary Report of NICHD International Site Development Initiative (NISDI) Pediatric Study
Maria Cruz*1, J Korelitz2, L Freimanis2, E João1, J Menezes1, G Bazin1, D Machado3, R Oliveira4, J Pinto5, M Mussi-Pinhata6, E Cardoso7, P Cahn8, M Cashat9, and L Serchuck10
1Hosp dos Servidores do Estado, Rio de Janeiro, Brazil; 2Westat, Rockville, MD, USA; 3Federal Univ of São Paulo, Brazil; 4Federal Univ of Rio de Janeiro, Brazil; 5Fed Univ of Minas Gerais Sch of Med, Belo Horizonte, Brazil; 6Univ of São Paulo, Ribeirão Preto, Brazil; 7Hosp Conceição, Porto Alegre, Brazil; 8Fndn Huésped, Buenos Aires, Argentina; 9Hosp Infantil de México Federico Gómez, México City, México; and 10NICHD, NIH, DHHS, Bethesda, MD, USA

Background:  An increasing number of perinatally infected children are reaching adolescence in countries where antiretroviral (ARV) drugs are available.

Methods:  The Nartional Institutes of Health (NIH) National Institute if Child Health and Human Development (NICHD) International Site Development Initiative (NISDI) Pediatric Study observed a cohort of HIV-exposed and infected children and adolescents in 15 clinical sites in Brazil, Argentina, and Mexico. We analyzed data from HIV-infected patients who were 12 to 19 years old at enrollment as to their mode of HIV acquisition and evaluated clinical, immune, and ARV treatment  status in those with perinatally acquired infection.

Results:  From September 2002 to June 2004, 109 HIV-infected adolescents 12 to 19 years old were enrolled in NISDI. Sixty-seven of 109 (61%) acquired their infection perinatally, whereas the remainder acquired the infection via other routes (25 [23%] consensual sex, 10 [9%] by blood transfusion, and 7 [6 %] unknown risk factors). At entry into NISDI, 64% of perinatally infected adolescents were CDC Clinical Class B or C, and 73% had at least moderate immune suppression (Immune Class 2 or 3). Thirty percent of perinatally infected adolescents did not have their first positive HIV diagnostic test until age 10 to 15 years. At enrollment into NISDI, 66 of 67 (96%) of perinatally-infected adolescents were receiving ARV: 19 (29%) started ARV at age 1 to 5 years; 40 (60%) started at 6 to 11 years; and 7 (10%) started at 12 years or older. Despite ARV use, over a third of perinatally infected adolescents receiving ARV had severe immune suppression at enrollment into NISDI: 37% of those who started ARV at age 1 to 5 years; 30% starting at age 6 to 11 years; and 57% starting age > 12 years (p = 0.38). By age 12 years, 25 (37%) perinatally infected adolescents were still on their first ARV regimen; 20 (30%) were on their second; and 10 (15%) were on their third regimen. In those still receiving their first ARV regimen, 13 (52%) were receiving only dual NRTI combinations. Twenty-one perinatally infected adolescents had their first HIV diagnostic test at age 10 to 14 for those who had exams performed while ARV naïve viral load ranged from 2,500 to 500,000 copies and CD4 from 247 to 767 cells/mm3.

Conclusions:  Latin American perinatally infected adolescents in NISDI have moderate to severe HIV infection and immunosuppression, although most of them had been on ART since childhood. Diagnosis is frequently made after age 10 in a very heterogeneous group in terms of CD4 count and viral load. 

Keywords: Adolescents; Disease progression; ART