Objective: To characterize the clinicopathological manifestations and outcomes of a cohort of HIV-infected Jamaican adolescents.
Methods: This is a retrospective cohort study to determine demographic, clinical, immunological characteristics, antiretroviral uptake and mortality in 94 adolescents aged 10–19 years followed in the Kingston Paediatric and Perinatal HIV/AIDS Programme (KPAIDS) between September 2002 and May 2007. Parametric and non-parametric tests are used to compare variables.
Results: The median age at initial presentation was 10.0 years (interquartile range (IQR) 7.0–12.0 years), 54.3% (51) were female (p = 0.024), transmission was primarily mother-to-child (70, 73.4%), with 87% (61) of the latter presenting as slow progressors. Sexual transmission accounted for 19.1% and there was significant female predominance (n = 15; p = 0.024). At most recent visit, perinatally infected adolescents were more likely (p < 0.0001) to reside with a non-parent (n = 42) than a biological parent (n = 19) and most had Centers for Disease Control and Prevention (CDC) category C (35/50%) disease, whereas the majority of non-perinatally infected children were classified CDC category A. Mean z scores for height-for-age was -1.47 ± 1.21 (n = 77), weight-for-age -1.06 ± 1.44 (n = 80) and BMI-for-age -0.34 ± 1.21 (n = 76) respectively; females (n = 41) were taller than males (n = 36) at their current height (p = 0.031). Lymphadenopathy (82%), dermatitis (72.0%), hepatomegaly (48%) and parotitis (48%) were the most common clinical manifestations, with significant predilection for lymphadenopathy (p # 0.0001), dermatitis (p = 0.010), splenomegaly (p = 0.008), hepatomegaly (p = 0.001) and parotitis (p = 0.007) among perinatally infected children. Median baseline CD4+ cell count was 256.0/μL (IQR 71.0 – 478.0 cells/μL); median most recent CD4+ cell count was 521/μL (IQR 271.0 – 911.0 cells/μL). Seventy-six per cent (n = 71) were initiated with highly active antiretroviral therapy (HAART) and 62 (87.3%) were currently receiving first-line therapy. Six behaviourally infected females became pregnant, resulting in five live births. There were seven deaths (7.4%).
Conclusion: This study comprehensively characterizes HIV infection among perinatally infected teens with predominantly slow-progressor disease and an increasing population of sexually-infected adolescents. As the cohort transitions to adulthood, adolescent developmental, mental health and life planning issues must be emergently addressed.