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Promising Long-term Outcomes for Adolescents with Perinatal HIV Infection

Adolescents in France who acquired HIV through mother-to-child transmission during gestation or birth demonstrated relatively good outcomes, especially considering that optimal antiretroviral therapy (ART) was not yet available during their early years, researchers reported in the July 15, 2010 issue of Clinical Infectious Diseases.

Thanks to advances in antiretroviral treatment, mother-to-child HIV transmission has become uncommon in high-income countries, and individuals who were infected at birth in the late 1980s and early 1990s are surviving long enough to reach adolescence.

Catherine Dollfus and colleagues sought to learn more about the living conditions, overall health status, and clinical, immunological, and virological outcomes among this "pioneering generation" of adolescents who were born before the introduction of antiviral prophylaxis to prevent vertical transmission and who were diagnosed with HIV at a time when treatment options were limited.

The study population was drawn from a cohort of 348 HIV-infected children born between 1985 and 1993 who were included in the prospective national French Perinatal Cohort (EPF/ANRS CO10).

Out of this cohort, 210 participants (60%) were still alive in 2009 and receiving regular follow-up. This group had a median age of 15 years, half were boys and half were girls, and about one-third were born to mother from sub-Saharan Africa. Of the remainder, 47 (14%) died before 2 years of age, 58 (17%) died thereafter, and 33 (10%) were lost to follow-up.


  • 77% of study participants were currently receiving multi-class combination ART (HAART), while 5% were taking only 2 nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs) 2% had never started therapy.
  • 2% had never started therapy and 16% had stopped treatment.
  • The median CD4 cell count was 557 cells/mm3, and 94% had a CD4 count > 200 cells/mm3 (the threshold for an AIDS diagnosis).
  • Higher CD4 count was associated with younger age and starting HAART earlier.
  • The median viral load was 200 copies/mL.
  • 43% of adolescents overall, and 55% of those on HAART, had undetectable HIV RNA.
  • Undetectable viral load was associated with current HAART and mother's geographic origin, with children of Europeans faring better than those of Africans.
  • Median height, weight, and body mass index were similar to those of the French general population of the same sage.
  • 82% of participants were living with family members, including 65% with one or both parents.
  • 84% of participants were attending school and 13% were receiving vocational training; school achievement was similar to that of the French population at large.

"Given the limited therapeutic options available during the early years of these patients' lives and the challenge presented by treatment adherence during adolescence, the long-term outcomes among this population are encouraging," the investigators concluded.

Investigator affiliation: Assistance Publique-Hôpitaux de Paris (AP-HP), Service d’Hématologie et d’Oncologie Pédiatrique, Hôpital d’Enfants Armand Trousseau; AP-HP, Service de Pédiatrie Générale, Hôpital Robert Debré; AP-HP, Unité d’Immunologie Hématologie Pédiatrique, Hôpital Necker; AP-HP, Laboratoire de Virologie, Hôpital Necker; Université Paris Descartes 5, Equipe d'Accueil EA3620; Epidémiologie du VIH et des IST, Centre de Recherche en Epidémiologie et Santé des Populations, Unité INSERM 1018, Faculté de Médecine Paris Sud, Université Paris Sud; AP-HP, Service de Santé Publique et Epidémiologie, Hôpital Bicêtre, Le Kremlin-Bicêtre, Paris, France.



C Dollfus, J Le Chenadec, A Faye, and others. Long-term outcomes in adolescents perinatally infected with HIV-1 and followed up since birth in the French perinatal cohort (EPF/ANRS CO10). Clinical Infectious Diseases 51(2): 214-224. July 15, 2010.