philippa musoke mbchb phd department of paediatrics and child health
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Complications of HIV in perinatally infected adolescents and young adults in resource-poor settings. Philippa Musoke MBChB PhD Department of Paediatrics and Child Health College of Health Sciences, School of Medicine Makerere Unversity Kampala Uganda and MUJHU Research Collaboration. - PowerPoint PPT PresentationTRANSCRIPT
Complications of HIV in perinatally infected adolescents and young adults
in resource-poor settings
Philippa Musoke MBChB PhDDepartment of Paediatrics and Child HealthCollege of Health Sciences, School of MedicineMakerere UnversityKampala UgandaandMUJHU Research Collaboration
OutlineComplications of HIV infection in adolescentso Malnutrition
o Chronic lung disease
o Tuberculosis
o Lipodystrophy
Malnutrition and HIV infection Most HIV infected children are malnourished
Median wt- and ht-for-age z-score <-2 In 30 different studies of children on ART (Sutclife)
30 – 50% of children hospitalized with severe acute malnutrition (SAM) are HIV+ (Bachou H)
Mortality of children with HIV and SAM is 4 times higher than those with SAM alone (30% vs 8%) (Fergusson P)
Severe pneumonia and SAM were risk factors for death in hospitalized children (Preidis GA J Pediatr 2011)
Fergusson P, et al Trans R Soc Trop Med Hyg 2008; Sutcliffe et al CG , Bachou H et al. Nutr J 2006,
Adolescents physical changes
Stunted and wasted
Dermatological changes
Puberty delayed
Complications from ART
STUNTING in HIV infected sibling
Severe malnutrition post ART ARROW trial – Compared children who were hospitalized
with SAM ( both edematous and non-edematous types) and those not hospitalized
39/1207 (3.2%) were hospitalized (20 with edema) Median days after ART initiation = 27 days
Age median 6 years (3-17 years)
Children with advanced disease n =220 (CD4% & WAZ<-3 SD) 7.3% (95% CI 3.8–10.7) kwashiorkor (K) 3.2 % (95% CI 1.2–6.1) marasmus (M)
Mortality at 24 wks - 32% marasmus; 20% kwashiorkor - compared to 1.7 % for non hospitalized children
Prendergast A et al AIDS 2011
Chronic Lung disease in adolescents
HIV infected ART naïve adolescents N=116 (Zimbabwe) Mean Age: 14 years + 2.6 years 43% male Chronic cough 66% >40% had hypoxia at rest Pathology: small airway disease associated
with bronchiectasis
Ferrand RA et al CID 2011
Increase incidence of Tuberculosis disease in HIV infected
children Cohort of south African children randomized to INH or
placebo(548 HIV+ and 804 HIV- infants) (Smith) 121 TB cases /1000 child-years (CI 95-153) HIV+
41 TB cases/1000 child-years (CI 31-52) HIV – No benefit of INH prophylaxis
IRIS (20-30% of children on ART) 29% of IRIS events in children were TB –Uganda
(Orikiriiza) 71% % of IRIS events in children were TB –S.Africa
(Mahdi) Majority BCG adenitis Mahdi SA et al NEJM 2011; Orikiriiza J et al AIDS 2009; Smith K et al AIDS 2009
Prevalence of Immune Reconstitution Syndrome
Cohort of 162 Ugandan children on ART 38% ( CI 31-36) developed IRIS Median Age 6 years (IQR 2.5-12 years) Tuberculosis was the most common event=29% Others - pruritic papular eruptions (PPE) , candida
and pneumonia
Factors associated with IRIS Male sex OR 2.96 (1.30-6.74) Pre-ART CD4% OR 4.39 (1.62-11.08) CD8+ < 1000 cells/ul OR 4.56 (2.01-10.34) Cough(current) OR 4.30 (1.84-10.08)
Orikiriiza J et al AIDS 2010
Lipodystrophy in Resource-Limited Settings
Thailand 90 HIV+ children on ART (NNRTI) Lipodystrophy – 9%, 47% and 65% at 48, 96 and 144 weeks 11% dyslipidemia
India 52 HIV + children ( 25 ART – non PI, 27 not on ART) Only 4 had cholesterol 2 lipoatrophy, 3 triglycerides ( follow up 3 months)
Brazil 30 children (30% on PI) median duration on ART 28 mths 53% lipodystrophy, 60% dyslipidemia
Aurpibul L et al Antivir Ther 2007; Parakh A Indian J Pediatr; Sarni RO et al J Pediatr
Lipodystrophy on ART 364 children enrolled in a cross sectional study, Uganda
Median age was 8 years ( range 2-18) Prevalence of fat redistribution was 27%
Only 29% of them also had hyperlipidaemia Prevalence of hyperlipidemia was 34%
Factors associated with fat redistributionTanner stage >2, age > 5yrs and use of d4T regimen
J Int AIDS Soc. 2012
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