Infectious disease
How do teens born with HIV fare in different parts of the world?
Open access · cc by · source: Europe PMC
Adolescents born with HIV in sub-Saharan Africa, Asia and Latin America started treatment years later and were several times more likely to die in early adolescence than those in Europe.
Study at a glance
- Design
- Cohort — Retrospective analysis of pooled individual data from 12 paediatric HIV cohort networks (CIPHER); competing-risks cumulative incidence and Cox models of mortality from age 10 to 15, with Europe as reference.
- N
- N=38187 · 38,187 adolescents with perinatally acquired HIV (in care before and after age 10) drawn from 183,119 children in the pooled dataset.
- Population
- Adolescents aged 10-19 with perinatally acquired HIV in 51 countries across Europe, North America, South America and the Caribbean, South and Southeast Asia, and sub-Saharan Africa.
- Outcome
- Characteristics at first visit, ART start, age 10 and last visit (age, CD4, height-for-age), and mortality, transfer out and loss to follow-up between ages 10 and 15.
Structured fields used in claim comparison tables when every cited study has a complete layer.
Key findings
Of the 38,187 adolescents, 79% lived in sub-Saharan Africa. Median age at starting antiretroviral therapy was 0.9 years in North America but 7.9 years in sub-Saharan Africa, and many adolescents outside Europe and North America remained stunted. By age 15, cumulative mortality was 2.6% overall, from 0.8% in Europe to 4.4% in South America and the Caribbean; compared with Europe, the unadjusted mortality hazard ratio was 4.35 in sub-Saharan Africa and 6.07 in South America and the Caribbean. Children born in 2000-2005 had lower mortality than earlier birth cohorts, but loss to follow-up more than doubled.
Methodology
The researchers combined records from 12 paediatric HIV research and care networks into one dataset and selected children who were in HIV care before age 10 and again after, as a proxy for infection at birth. They compared age at first care and treatment start, immune status (CD4) and growth across regions, country income groups and birth years. They then estimated the chance of dying, transferring to another clinic, or being lost to follow-up between ages 10 and 15, treating these as competing outcomes.
Limitations
Deaths among adolescents lost to follow-up were probably missed, especially in sub-Saharan Africa where loss to follow-up was highest, so regional mortality differences are uncertain; sensitivity analyses showed estimates could shift greatly depending on assumptions. Perinatal infection was inferred from entering care before age 10 rather than recorded, Nigeria was not included, and North America was represented only by the US. The data come from clinics that may offer better care than average, and about 44% of cohorts only enrolled children already on ART, so treatment coverage and survival are likely overestimated.
How this study connects
Role on claims
Each row is a claim on a concept or method page where this paper supports, challenges, or qualifies the statement. Roles are hand-checked — not a model guess.
Where and when treatment starts shapes survival into adolescence.
Among 38,187 adolescents with perinatal HIV in 51 countries, antiretroviral therapy began at a median 0.9 years in North America but 7.9 years in sub-Saharan Africa, and cumulative mortality by age 15 ranged from 0.8% in Europe to 4.4% in South America and the Caribbean.
Evidence for the claim as stated.
The TB cohort and the adolescent cohort measure HIV's toll in different ways: incidence and diagnostic delay in adults without routine ART versus survival and retention in children on ART. They are not comparable estimates of the same effect, and both are observational.
Evidence for the claim as stated.
Open questions
Tensions this paper is part of
From concept pages' “where studies disagree.” Disagreement means the same question; scope means different assays, populations, or outcomes.
The TB cohort and the adolescent cohort measure HIV's toll in different ways: incidence and diagnostic delay in adults without routine ART versus survival and retention in children on ART. They are not comparable estimates of the same effect, and both are observational.
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Same topic cluster — not a recommendation engine.