Frontiers in Pediatrics (Jul 2021)

Real-World Analysis of Survival and Clinical Events in a Cohort of Italian Perinatally HIV-1 Infected Children From 2001 to 2018

  • Elena Chiappini,
  • Elena Chiappini,
  • Francesca Larotonda,
  • Francesca Larotonda,
  • Catiuscia Lisi,
  • Catiuscia Lisi,
  • Vania Giacomet,
  • Paola Erba,
  • Stefania Bernardi,
  • Paola Zangari,
  • Antonio Di Biagio,
  • Lucia Taramasso,
  • Carlo Giaquinto,
  • Osvalda Rampon,
  • Clara Gabiano,
  • Silvia Garazzino,
  • Claudia Tagliabue,
  • Susanna Esposito,
  • Eugenia Bruzzese,
  • Raffaele Badolato,
  • Domenico Zanaboni,
  • Monica Cellini,
  • Maurizio Dedoni,
  • Antonio Mazza,
  • Andrea Pession,
  • Anna Maria Giannini,
  • Filippo Salvini,
  • Icilio Dodi,
  • Ines Carloni,
  • Salvatore Cazzato,
  • Pier Angelo Tovo,
  • Maurizio de Martino,
  • Maurizio de Martino,
  • Luisa Galli,
  • Luisa Galli

DOI
https://doi.org/10.3389/fped.2021.665764
Journal volume & issue
Vol. 9

Abstract

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Background: Combined antiretroviral therapy (cART) has been associated with a steep decrease in mortality and morbidity in HIV-1 infected children. New antiretroviral molecules and drug classes have been developed and the management of HIV-infected children has improved, but recent data on survival are limited.Methods: An observational retrospective study investigating changes in mortality and morbidity was conducted on 1,091 perinatally HIV-1 infected children enrolled in the Italian Register for HIV Infection in Children and followed-up from 2001 to 2018.Results: Three hundred and fifty-four (32%) AIDS events and 26 (2%) deaths occurred overtime. Mortality rates decreased from 0.4/100 person-years in 2001–2006 to 0.27/100 person-years in 2007–2012 and 0.07/100 person-years in 2013–2018. Notably, 92% of the dead children were born in Italy, but only 50% were followed-up since birth or within three months of age. Seventy three percent of children had started cART at age ≥6 months; 23% were treated for <30 days before death. B and C clinical events progressively decreased (P < 0.0001). Opportunistic infections significantly decreased over time, but still were the most common events in all the periods (6.76/100 person-years in 2013–2018). In the last period, severe bacterial infections were the most common ones. Cancer rates were 0.07/100; 0.17/100; 0.07/100 person-years in the three periods, respectively.Conclusions: Progressive reductions both in mortality and in rates of class B and C clinical events and OIs have been observed during the cART era. However, deaths were still registered; more than half of dead children were enrolled after birth and had belatedly started cART.

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