Multisystem impairment in South African adolescents with Perinatally acquired HIV on antiretroviral therapy ( ART )

Abstract Introduction Adolescents with perinatally acquired HIV ( PHIV ) are at risk of chronic disease due to long‐standing immune suppression, HIV disease and antiretroviral therapy ( ART ) exposure. However, there are few data on multisystem disease in this population. We investigated the overlapping burden of neurocognitive, cardiovascular, respiratory and/or renal impairment among PHIV positive ( PHIV +) adolescents. Methods In this cross‐sectional analysis, participants aged 9 to 14 years on ART for >6 months were recruited from seven sites across Cape Town from July 2013 through March 2015, together with age‐matched HIV‐negative ( HIV‐ ) adolescents. Impairment at enrolment was assessed across neurocognitive functioning (using the youth‐International HIV Dementia Scale); cardiac function (echocardiogram abnormality); respiratory function (abnormal spirometry) and renal function (abnormal glomerular filtration rate). Results and Discussion Overall, 384 PHIV + and 95 HIV‐ adolescents were included (mean age, 11.9 years; 49% female). Median age of ART initiation was 4.2 years ( IQR : 1.7 to 7.6) and median CD 4 count was 709 ( IQR : 556 to 944) with 302 (79%) of PHIV + adolescents virologically suppressed. Abacavir and Zidovudine were the most commonly used nucleoside reverse transcriptase inhibitors ( NRTI s) with 60% of adolescents on non‐nucleoside reverse transcriptase inhibitors ( NNRTI ) and 38% on a protease inhibitor ( PI ). Among PHIV + adolescents, 167 (43.5%) had single system impairment only, 110 (28.6%) had two systems involved, and 39 (10.2%) had three or four systems involved. PHIV + participants had more 2‐system and 3‐system impairment than HIV‐ , 110 (28.6%) versus 17 (17.9%), p  =   0.03 and 39 (10.2%) versus 3 (4.3%), p  =   0.03. PHIV + participants who had failed a year of school (73.8% vs. 46.4%, p  =   0.00) and with a viral load >1000 copies/mL at enrolment (16.8% vs. 8.1%, p  =   0.03) were more likely to have dual or multisystem impairment. Of those with cardiac impairment, 86.7% had an additional system impaired. Similarly, in those with neurocognitive impairment, almost 60% had additional systems impaired and of those with respiratory impairment, 74% had additional systems impaired. Conclusions Despite relatively early ART initiation, there is a substantial burden of multisystem chronic impairment among PHIV + adolescents. This phenomenon needs to be further explored as this population ages and begins to engage in adult lifestyle factors that may compound these impairments.