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24-month clinical, immune-virological outcomes and HIV status disclosure in adolescents living with perinatally-acquired HIV in the COHADO cohort, in Togo and Côte d’Ivoire, 2015-2017
Valériane Leroy
Corresponding Author
ORCiD: https://orcid.org/0000-0003-3542-8616
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Adolescents living with perinatally-acquired HIV (APHIV) face challenges including the disclosure of their HIV-serostatus that we explored in the West-African COHADO cohort. We assessed the 24-month outcomes among APHIV in relation to the disclosure of their own HIV-serostatus.
Methods: Nested within the International epidemiologic Database to Evaluate AIDS pediatric West African prospective cohort (IeDEA pWADA), the COHADO cohort included antiretroviral (ART)-treated APHIV aged 10–19 years, enrolled in HIV-care <10 years, in Abidjan (Côte d’Ivoire) and Lomé (Togo) in 2015. An unfavorable outcome was defined when either death, loss to follow-up, progression to WHO-AIDS stage, a decrease of CD4 count >10% compared to baseline, or a detectable viral load (>50copies/mL) were notified at 24 months. None of these events defined a favorable outcome. We investigated correlates of APHIV favorable 24-month outcome using a logistic regression model.
Results: Overall, 209 APHIV were included, 51.6% in Abidjan, 54.5% were females. At inclusion, median CD4 cell count was 521/mm3 (IQR[281-757]); 29.6% had a VL measurement of whom 3.2% in virological suppression. APHIV were younger in Lomé (median age: 12 years (interquartile range [IQR]:11-15) compared to Abidjan (14 years (IQR:12-15, p=0.01). Full HIV-disclosure increased from 41.6% at inclusion to 74.1% after 24 months. After 24 months of follow-up, 6 (2.9%) died, 8 (3.8%) were lost to follow-up, 4 (1.9%) were transferred out. Overall, 73.7% did not progress to WHO-AIDS stage, 62.7% had CD4 count above (± 10%) of the baseline value (48.6% in Abidjan versus 69.0% in Lomé, p<0.001). Among the 83.7% with VL measurements, 48.8% were in virological suppression (Abidjan: 45.4%, Lomé: 52.5%, p<0.01). The 24-month combined outcome was favorable for 45% (29.6% in Abidjan and 61.4% in Lomé, p<0.01): adjusted on baseline variables, it was not significantly associated with HIV-disclosure but significantly higher for APHIV living in Lomé compared to those in Abidjan (aOR: 17.24, 95%CI [3.69-80.44]).
Conclusions: 24-month favorable outcome rates were low among West-African APHIV and differed across countries. HIV-disclosure frequency improved over time but remained low. Context-specific responses are urgently needed to improve adolescent’s care to reach the UNAIDS 90% target of virological success for those on ART.
Keywords
Adolescents, HIV, disclosure, retention, West-Africa
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Learn more about In Review
Research article
24-month clinical, immune-virological outcomes and HIV status disclosure in adolescents living with perinatally-acquired HIV in the COHADO cohort, in Togo and Côte d’Ivoire, 2015-2017
Valériane Leroy
Corresponding Author
ORCiD: https://orcid.org/0000-0003-3542-8616
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 3
Posted 22 Jun, 2020
No community comments so far
Editor assigned
On 19 Jun, 2020
Submission checks complete
On 18 Jun, 2020
Editor invited
On 18 Jun, 2020
No comments provided
Editorial decision: Major revision
On 28 Apr, 2020
Reviewer #4 agreed
On 21 Apr, 2020
Reviewers invited
Invitations sent on 09 Apr, 2020
Reviewer #1 agreed
On 09 Apr, 2020
Reviewer #2 agreed
On 09 Apr, 2020
Reviewer #3 agreed
On 09 Apr, 2020
Review #2 received
Received 09 Apr, 2020
Review #1 received
Received 09 Apr, 2020
Review #3 received
Received 09 Apr, 2020
Editor assigned
On 06 Apr, 2020
Submission checks complete
On 05 Apr, 2020
Editor invited
On 05 Apr, 2020
No comments provided
Editorial decision: Minor revision
On 24 Dec, 2019
Review #11 received
Received 22 Dec, 2019
Reviewer #17 agreed
On 16 Dec, 2019
Review #3 received
Received 16 Dec, 2019
Reviewer #16 agreed
On 15 Dec, 2019
Reviewer #15 agreed
On 14 Dec, 2019
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Received 14 Dec, 2019
Review #10 received
Received 14 Dec, 2019
Reviewer #14 agreed
On 13 Dec, 2019
Reviewer #13 agreed
On 13 Dec, 2019
Reviewer #11 agreed
On 12 Dec, 2019
Reviewer #12 agreed
On 12 Dec, 2019
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On 11 Dec, 2019
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On 11 Dec, 2019
Review #2 received
Received 10 Dec, 2019
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Received 10 Dec, 2019
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Received 10 Dec, 2019
Review #5 received
Received 10 Dec, 2019
Reviewer #2 agreed
On 10 Dec, 2019
Reviewer #3 agreed
On 10 Dec, 2019
Reviewer #4 agreed
On 10 Dec, 2019
Reviewer #5 agreed
On 10 Dec, 2019
Reviewer #6 agreed
On 10 Dec, 2019
Review #1 received
Received 17 Nov, 2019
Reviewer #1 agreed
On 07 Nov, 2019
Reviewers invited
Invitations sent on 02 Nov, 2019
Submission checks complete
On 02 Oct, 2019
Editor assigned
On 27 Sep, 2019
Editor invited
On 26 Sep, 2019
First submitted
On 24 Sep, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Adolescents living with perinatally-acquired HIV (APHIV) face challenges including the disclosure of their HIV-serostatus that we explored in the West-African COHADO cohort. We assessed the 24-month outcomes among APHIV in relation to the disclosure of their own HIV-serostatus.
Methods: Nested within the International epidemiologic Database to Evaluate AIDS pediatric West African prospective cohort (IeDEA pWADA), the COHADO cohort included antiretroviral (ART)-treated APHIV aged 10–19 years, enrolled in HIV-care <10 years, in Abidjan (Côte d’Ivoire) and Lomé (Togo) in 2015. An unfavorable outcome was defined when either death, loss to follow-up, progression to WHO-AIDS stage, a decrease of CD4 count >10% compared to baseline, or a detectable viral load (>50copies/mL) were notified at 24 months. None of these events defined a favorable outcome. We investigated correlates of APHIV favorable 24-month outcome using a logistic regression model.
Results: Overall, 209 APHIV were included, 51.6% in Abidjan, 54.5% were females. At inclusion, median CD4 cell count was 521/mm3 (IQR[281-757]); 29.6% had a VL measurement of whom 3.2% in virological suppression. APHIV were younger in Lomé (median age: 12 years (interquartile range [IQR]:11-15) compared to Abidjan (14 years (IQR:12-15, p=0.01). Full HIV-disclosure increased from 41.6% at inclusion to 74.1% after 24 months. After 24 months of follow-up, 6 (2.9%) died, 8 (3.8%) were lost to follow-up, 4 (1.9%) were transferred out. Overall, 73.7% did not progress to WHO-AIDS stage, 62.7% had CD4 count above (± 10%) of the baseline value (48.6% in Abidjan versus 69.0% in Lomé, p<0.001). Among the 83.7% with VL measurements, 48.8% were in virological suppression (Abidjan: 45.4%, Lomé: 52.5%, p<0.01). The 24-month combined outcome was favorable for 45% (29.6% in Abidjan and 61.4% in Lomé, p<0.01): adjusted on baseline variables, it was not significantly associated with HIV-disclosure but significantly higher for APHIV living in Lomé compared to those in Abidjan (aOR: 17.24, 95%CI [3.69-80.44]).
Conclusions: 24-month favorable outcome rates were low among West-African APHIV and differed across countries. HIV-disclosure frequency improved over time but remained low. Context-specific responses are urgently needed to improve adolescent’s care to reach the UNAIDS 90% target of virological success for those on ART.
Figure 1