First global comparison reveals stark health inequalities among adolescents born with HIV.

23 April 2018

New research highlights significant gaps in health outcomes for adolescents born with HIV across the world – but paints a hopeful picture for the future as treatment access expands.

young people hold a globe together

New research highlights significant gaps in health outcomes for adolescents born with HIV across the world – but paints a hopeful picture for the future as treatment access expands.

PLOS Medicine has published the first global comparison of health outcomes for adolescents living with HIV acquired through mother-to-child transmission. The results shed light on the extent to which health inequalities still exist among adolescents across the world, despite antiretroviral treatment (ART) having greatly reduced inequality among adult and child populations.

Through a retrospective longitudinal analysis, researchers compared treatment outcomes among adolescent populations across five regions worldwide: North America, Europe, sub-Saharan Africa, South and Southeast Asia and South America and the Caribbean.

In using retrospective data, the study sample was also able to compare adolescents who were born with HIV at different periods of time, dividing participants into those born prior to 1995, between 1995 and 1999 and those born between 2000 and 2005.

With a cohort of over 38,000 adolescents, the study provides the largest analysis of global HIV epidemiology among this age group.

Some of the poorest health outcomes were found in sub-Saharan Africa. The average age of children from sub-Saharan Africa starting antiretroviral treatment was 7.9 years compared to 0.9 in North America.

The researchers found that there was a strong link between a country’s income and the health outcomes of the adolescents born with HIV. Those living in higher income countries had the lowest mortality and were starting ART younger. They also had higher CD4 counts and less impaired height when they started treatment.

The geographical findings reflect these economic trends, with results showing adolescents in North America and Europe having better health outcomes. Here, they entered into HIV care earlier, started ART younger and had less impaired height.

At 15 years of age, the average global incidence of mortality was 15.6%. However, there was a lot of variation across the regions. Sub-Saharan Africa, South and Southeast Asia and South America and the Caribbean had higher rates of mortality than other regions.

Comparisons by birth year provided some evidence that mortality was decreasing among adolescent populations. Those born later (2000-2005) were more likely to have started ART earlier and had much lower mortality rates than the older cohort. None of the study participants born between 2000 and 2005 in Europe, North America or South America and the Caribbean had died. 

The study also investigated rates of loss to follow up, as adherence and staying in care has been identified as one of the key challenges in treating an adolescent population who are transitioning from paediatric to adult care. They found that loss to follow up was lowest in South America and the Caribbean, at 4.4%, and highest in sub-Saharan Africa, at 13.2%.  

The study was part of the Collaborative Initiative for Paediatric HIV Education and Research (CIPHER), an ongoing global project that seeks to understand epidemiological factors among adolescents living with HIV. It helps develop a better understanding of the factors at play in adolescent populations that cannot be explained by treatment alone.

The researcher’s comment that, as more “children with HIV acquired around the time of birth or through breastfeeding (perinatally acquired HIV) are surviving into adolescence… better understanding is required to inform the appropriate policy responses to meet the needs of this dynamic and complex population… There is still much work to be done to achieve equality in health and survival for all adolescents living with perinatally acquired HIV, irrespective of geographic location.”

Photo credit:
istock/franckreporter

Written by Francesca Harrington-Edmans

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