Browsing by Author "Van Heerden, Linda"

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    A cross sectional analysis of perinatally HIV-infected (PHIV) adolescents in a paediatric infectious diseases clinic in the Western Cape, South Africa
    (Stellenbosch : Stellenbosch University, 2018-09) Van Heerden, Linda; Frigati, Lisa; Cotton, Mark F.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Paediatrics and Child Health.
    ENGLISH ABSTRACT: Background Approximately 1.8 million adolescents were living globally with HIV in 2015. HIV is the leading cause of death in adolescents in Africa and the second leading cause of death in adolescence worldwide. Perinatally HIV-infected (PHIV) adolescents often have chronic complications due to late access to antiretroviral therapy (ART) and ART side effects. There is relatively little information on their psychosocial outcomes although poor adherence has been described. The aim of this study was to describe a cohort of perinatally HIV infected adolescents (PHIVA) attending Tygerberg Hospital, a tertiary hospital in the Western Cape in 2015. Material and Methods A retrospective descriptive study (folder review) describing all HIV- infected adolescents between the ages of 10 and 19 years attending the Infectious Diseases Clinic (IDC) during a 12 month period in 2015 was performed. Results Ninety-eight of approximately 400 (25%) patients attending the Tygerberg Paediatric IDC were adolescents. Of these, 55 (56%) were female. Median age at first clinic visit was 4.9 years (IQR 1.5- 9.4). Median age at most recent clinic visit was 14 years (IQR: 10-19). The majority were WHO clinical stage 3 and 4 at diagnosis (74%). Twenty-eight (28%) adolescents were on their original ART regimen with no change in drug for side effects, failure or intolerance. Sixty-seven (68%) remained on their first regimen with a single drug switch due to side effects. Fifty of sixty -one adolescents (82%) starting on Efavirenz remained on it. Of 94 adolescents with a viral load available at last clinic visit, 71 (81%) were virologically suppressed. Viral genotyping was done in 7 of the 17 adolescents (41%) with viral loads above 1000 copies/ml. Only 3 (3%) were on third line drugs. Few adolescents had chronic medical complications: 23/98 adolescents (23%) were documented to have chronic lung disease (CLD) with 58 (59%) previously having Pulmonary Tuberculosis (PTB), 2 (2%) having had multidrug resistant (MDR) Tuberculosis and 1 (1%) having had Extremely Drug Resistant (XDR) Tuberculosis. Four (4%) had cardiac disease, 1 (1%) had HIV related renal disease, 80 (80%) had documented dermatological complications. Forty-one (42%) had central nervous system complications such as seizures and neurodevelopmental delay. The median number of documented hospitalizations since diagnosis was 3 (IQR: 1-4) with no deaths in 2015. Sixty-eight percent (68%) of adolescents knew their HIV status. There was no documentation in 20 (20%), while 11 (11 %) were not disclosed to. For the latter, 7 had severe neurological disease. Fortyfive (55%) attended mainstream school and 34 (34%) a special school/care centre. Forty-six (47%) had failed a grade and 33 (33%) failed more than one grade. Five (5%) were on antidepressants. Fifty-six (57%) had been referred to a social worker for complex psychosocial issues. When comparing those diagnosed at an age less than 10 years to those diagnosed older than 10 years the only statistic significant difference was a lower baseline absolute CD4 count in those diagnosed after ten years of age (265 vs 554, p = 0,003). There was no difference in WHO staging at diagnosis, chronic complications or social issues. Conclusions Despite relatively late access to ART, adolescents had good virological outcomes that compare with international cohorts. There are fewer chronic medical complications than noted in other African cohorts. However, there are significant psychosocial and educational issues and more focused interventions are needed to address these.