Introduction
Adolescents with perinatally acquired
HIV
(
PHIV
) are at risk of chronic disease due to long‐standing immune suppression,
HIV
disease and antiretroviral therapy (
ART
) exposure. However, there are few data on multisystem disease in this population. We investigated the overlapping burden of neurocognitive, cardiovascular, respiratory and/or renal impairment among
PHIV positive
(
PHIV
+) adolescents.
Methods
In this cross‐sectional analysis, participants aged 9 to 14 years on
ART
for >6 months were recruited from seven sites across Cape Town from July 2013 through March 2015, together with age‐matched
HIV‐negative
(
HIV‐
) adolescents. Impairment at enrolment was assessed across neurocognitive functioning (using the youth‐International
HIV
Dementia Scale); cardiac function (echocardiogram abnormality); respiratory function (abnormal spirometry) and renal function (abnormal glomerular filtration rate).
Results and Discussion
Overall, 384
PHIV
+ and 95
HIV‐
adolescents were included (mean age, 11.9 years; 49% female). Median age of
ART
initiation was 4.2 years (
IQR
: 1.7 to 7.6) and median
CD
4 count was 709 (
IQR
: 556 to 944) with 302 (79%) of
PHIV
+ adolescents virologically suppressed. Abacavir and Zidovudine were the most commonly used nucleoside reverse transcriptase inhibitors (
NRTI
s) with 60% of adolescents on non‐nucleoside reverse transcriptase inhibitors (
NNRTI
) and 38% on a protease inhibitor (
PI
). Among
PHIV
+ adolescents, 167 (43.5%) had single system impairment only, 110 (28.6%) had two systems involved, and 39 (10.2%) had three or four systems involved.
PHIV
+ participants had more 2‐system and 3‐system impairment than
HIV‐
, 110 (28.6%) versus 17 (17.9%),
p
=
0.03 and 39 (10.2%) versus 3 (4.3%),
p
=
0.03.
PHIV
+ participants who had failed a year of school (73.8% vs. 46.4%,
p
=
0.00) and with a viral load >1000 copies/mL at enrolment (16.8% vs. 8.1%,
p
=
0.03) were more likely to have dual or multisystem impairment. Of those with cardiac impairment, 86.7% had an additional system impaired. Similarly, in those with neurocognitive impairment, almost 60% had additional systems impaired and of t...