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Philippa Musoke MBChB PhD Department of Paediatrics and Child Health

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Complications of HIV in perinatally infected adolescents and young adults in resource-poor settings. Philippa Musoke MBChB PhD Department of Paediatrics and Child Health College of Health Sciences, School of Medicine Makerere Unversity Kampala Uganda and MUJHU Research Collaboration. - PowerPoint PPT Presentation
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perinatally infected adolescents and young adults in resource-poor settings Philippa Musoke MBChB PhD Department of Paediatrics and Child Health College of Health Sciences, School of Medicine Makerere Unversity Kampala Uganda and MUJHU Research Collaboration
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Page 1: Philippa Musoke MBChB  PhD Department of  Paediatrics  and Child Health

Complications of HIV in perinatally infected adolescents and young adults

in resource-poor settings

Philippa Musoke MBChB PhDDepartment of Paediatrics and Child HealthCollege of Health Sciences, School of MedicineMakerere UnversityKampala UgandaandMUJHU Research Collaboration

Page 2: Philippa Musoke MBChB  PhD Department of  Paediatrics  and Child Health

OutlineComplications of HIV infection in adolescentso Malnutrition

o Chronic lung disease

o Tuberculosis

o Lipodystrophy

Page 3: Philippa Musoke MBChB  PhD Department of  Paediatrics  and Child Health

Malnutrition and HIV infection Most HIV infected children are malnourished

Median wt- and ht-for-age z-score <-2 In 30 different studies of children on ART (Sutclife)

30 – 50% of children hospitalized with severe acute malnutrition (SAM) are HIV+ (Bachou H)

Mortality of children with HIV and SAM is 4 times higher than those with SAM alone (30% vs 8%) (Fergusson P)

Severe pneumonia and SAM were risk factors for death in hospitalized children (Preidis GA J Pediatr 2011)

Fergusson P, et al Trans R Soc Trop Med Hyg 2008; Sutcliffe et al CG , Bachou H et al. Nutr J 2006,

Page 4: Philippa Musoke MBChB  PhD Department of  Paediatrics  and Child Health

Adolescents physical changes

Stunted and wasted

Dermatological changes

Puberty delayed

Complications from ART

Page 5: Philippa Musoke MBChB  PhD Department of  Paediatrics  and Child Health

STUNTING in HIV infected sibling

Page 6: Philippa Musoke MBChB  PhD Department of  Paediatrics  and Child Health

Severe malnutrition post ART ARROW trial – Compared children who were hospitalized

with SAM ( both edematous and non-edematous types) and those not hospitalized

39/1207 (3.2%) were hospitalized (20 with edema) Median days after ART initiation = 27 days

Age median 6 years (3-17 years)

Children with advanced disease n =220 (CD4% & WAZ<-3 SD) 7.3% (95% CI 3.8–10.7) kwashiorkor (K) 3.2 % (95% CI 1.2–6.1) marasmus (M)

Mortality at 24 wks - 32% marasmus; 20% kwashiorkor - compared to 1.7 % for non hospitalized children

Prendergast A et al AIDS 2011

Page 7: Philippa Musoke MBChB  PhD Department of  Paediatrics  and Child Health

Chronic Lung disease in adolescents

HIV infected ART naïve adolescents N=116 (Zimbabwe) Mean Age: 14 years + 2.6 years 43% male Chronic cough 66% >40% had hypoxia at rest Pathology: small airway disease associated

with bronchiectasis

Ferrand RA et al CID 2011

Page 8: Philippa Musoke MBChB  PhD Department of  Paediatrics  and Child Health

Increase incidence of Tuberculosis disease in HIV infected

children Cohort of south African children randomized to INH or

placebo(548 HIV+ and 804 HIV- infants) (Smith) 121 TB cases /1000 child-years (CI 95-153) HIV+

41 TB cases/1000 child-years (CI 31-52) HIV – No benefit of INH prophylaxis

IRIS (20-30% of children on ART) 29% of IRIS events in children were TB –Uganda

(Orikiriiza) 71% % of IRIS events in children were TB –S.Africa

(Mahdi) Majority BCG adenitis Mahdi SA et al NEJM 2011; Orikiriiza J et al AIDS 2009; Smith K et al AIDS 2009

Page 9: Philippa Musoke MBChB  PhD Department of  Paediatrics  and Child Health

Prevalence of Immune Reconstitution Syndrome

Cohort of 162 Ugandan children on ART 38% ( CI 31-36) developed IRIS Median Age 6 years (IQR 2.5-12 years) Tuberculosis was the most common event=29% Others - pruritic papular eruptions (PPE) , candida

and pneumonia

Factors associated with IRIS Male sex OR 2.96 (1.30-6.74) Pre-ART CD4% OR 4.39 (1.62-11.08) CD8+ < 1000 cells/ul OR 4.56 (2.01-10.34) Cough(current) OR 4.30 (1.84-10.08)

Orikiriiza J et al AIDS 2010

Page 10: Philippa Musoke MBChB  PhD Department of  Paediatrics  and Child Health

Lipodystrophy in Resource-Limited Settings

Thailand 90 HIV+ children on ART (NNRTI) Lipodystrophy – 9%, 47% and 65% at 48, 96 and 144 weeks 11% dyslipidemia

India 52 HIV + children ( 25 ART – non PI, 27 not on ART) Only 4 had cholesterol 2 lipoatrophy, 3 triglycerides ( follow up 3 months)

Brazil 30 children (30% on PI) median duration on ART 28 mths 53% lipodystrophy, 60% dyslipidemia

Aurpibul L et al Antivir Ther 2007; Parakh A Indian J Pediatr; Sarni RO et al J Pediatr

Page 11: Philippa Musoke MBChB  PhD Department of  Paediatrics  and Child Health

Lipodystrophy on ART 364 children enrolled in a cross sectional study, Uganda

Median age was 8 years ( range 2-18) Prevalence of fat redistribution was 27%

Only 29% of them also had hyperlipidaemia Prevalence of hyperlipidemia was 34%

Factors associated with fat redistributionTanner stage >2, age > 5yrs and use of d4T regimen

J Int AIDS Soc. 2012

Page 12: Philippa Musoke MBChB  PhD Department of  Paediatrics  and Child Health

THANK YOU


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