Outcomes and challenges in adolescents with HIV in France: a nationwide cohort study over 35 years.

Abstract

Objective: Most data published on adolescents with HIV (AWH) have been collected before the large diffusion of second-generation integrase strand transfer inhibitors (INSTI) among the pediatric population. We analyzed the nationwide ANRS-MIE CO10 Pediatric cohort to assess the changes over time in health and social outcomes of French AWH.

Design: The cohort enrolled children born in France since 1985 and, from 2005, children diagnosed with HIV at ≤13 years, including those born abroad if antiretroviral-naive at first medical care in France.

Methods: Adolescents aged ≥10 years at their last visit were included in this analysis. Their characteristics were compared between three periods of birth (1985-1993, 1994-1999, 2000-2010).

Results: Overall, 529 AWH were included. Their median age at first HAART initiation decreased from 94 to 29 months ( P  < 0.0001). At the last evaluation, the proportions of AWH receiving HAART, receiving INSTI, having HIV-RNA < 50 copies/mL and having CD4 count ≥500/μl increased over time ( P  < 0.0001), reaching 98·7%, 53.3%, 81.3% and 85·0%, respectively, for those born in 2000-2010. The proportion of maternal and paternal orphans decreased until 14.4% and 11.0%, respectively, for AWH born recently. Compared to middle adolescents (15-17 years) born in 1994-1999, those born in 2000-2010 demonstrated higher academic success (69·2% versus 42·3%) and less frequent academic failure (4.6% versus 6.2%).

Conclusions: Despite spectacular improvement in their health and immunovirological status, AWH remain vulnerable compared to other French adolescents, with a higher risk of being orphan and/or experiencing academic failure. Specific interventions are required to improve their global quality of life.