Real-World Analysis of Survival and Clinical Events in a Cohort of Italian Perinatally HIV-1 Infected Children From 2001 to 2018

Chiappini, E.; Larotonda, F.; Lisi, C.; Giacomet, V.; Erba, P.; Bernardi, S.; Zangari, P.; Di Biagio, A.; Taramasso, L.; Giaquinto, C.; Rampon, O.; Gabiano, C.; Garazzino, S.; Tagliabue, C.; Esposito, S.; Bruzzese, E.; Badolato, R.; Zanaboni, D.; Cellini, M.; Dedoni, M.; Mazza, A.; Pession, A.; Giannini, A. M.; Salvini, F.; Dodi, I.; Carloni, I.; Cazzato, S.; Tovo, P. A.; de Martino, M.; Galli, L.

doi:10.3389/fped.2021.665764

Background: Combined antiretroviral therapy (cART) has been associated with a steep decrease in mortality and morbidity in HIV-1 infected children. New antiretroviral molecules and drug classes have been developed and the management of HIV-infected children has improved, but recent data on survival are limited. Methods: An observational retrospective study investigating changes in mortality and morbidity was conducted on 1,091 perinatally HIV-1 infected children enrolled in the Italian Register for HIV Infection in Children and followed-up from 2001 to 2018. Results: Three hundred and fifty-four (32%) AIDS events and 26 (2%) deaths occurred overtime. Mortality rates decreased from 0.4/100 person-years in 2001–2006 to 0.27/100 person-years in 2007–2012 and 0.07/100 person-years in 2013–2018. Notably, 92% of the dead children were born in Italy, but only 50% were followed-up since birth or within three months of age. Seventy three percent of children had started cART at age ≥6 months; 23% were treated for <30 days before death. B and C clinical events progressively decreased (P < 0.0001). Opportunistic infections significantly decreased over time, but still were the most common events in all the periods (6.76/100 person-years in 2013–2018). In the last period, severe bacterial infections were the most common ones. Cancer rates were 0.07/100; 0.17/100; 0.07/100 person-years in the three periods, respectively. Conclusions: Progressive reductions both in mortality and in rates of class B and C clinical events and OIs have been observed during the cART era. However, deaths were still registered; more than half of dead children were enrolled after birth and had belatedly started cART.

Titolo:	Real-World Analysis of Survival and Clinical Events in a Cohort of Italian Perinatally HIV-1 Infected Children From 2001 to 2018
Autore/i:	Chiappini E.; Larotonda F.; Lisi C.; Giacomet V.; Erba P.; Bernardi S.; Zangari P.; Di Biagio A.; Taramasso L.; Giaquinto C.; Rampon O.; Gabiano C.; Garazzino S.; Tagliabue C.; Esposito S.; Bruzzese E.; Badolato R.; Zanaboni D.; Cellini M.; Dedoni M.; Mazza A.; Pession A.; Giannini A. M.; Salvini F.; Dodi I.; Carloni I.; Cazzato S.; Tovo P. A.; de Martino M.; Galli L.
Autore/i Unibo:	CHIAPPINI, EMILIO Larotonda F. Lisi C. Giacomet V. Erba P. Bernardi S. Zangari P. Di Biagio A. Taramasso L. Giaquinto C. Rampon O. Gabiano C. Garazzino S. Tagliabue C. Esposito S. Bruzzese E. Badolato R. Zanaboni D. CELLINI, MAURO Dedoni M. Mazza A. PESSION, ANDREA Giannini A. M. Salvini F. Dodi I. Carloni I. CAZZATO, SALVATORE Tovo P. A. DE MARTINO, SARA ROSA MARIA Galli L. mostra contributor esterni nascondi contributor esterni
Anno:	2021
Rivista:	FRONTIERS IN PEDIATRICS
Digital Object Identifier (DOI):	http://dx.doi.org/10.3389/fped.2021.665764
Abstract:	Background: Combined antiretroviral therapy (cART) has been associated with a steep decrease in mortality and morbidity in HIV-1 infected children. New antiretroviral molecules and drug classes have been developed and the management of HIV-infected children has improved, but recent data on survival are limited. Methods: An observational retrospective study investigating changes in mortality and morbidity was conducted on 1,091 perinatally HIV-1 infected children enrolled in the Italian Register for HIV Infection in Children and followed-up from 2001 to 2018. Results: Three hundred and fifty-four (32%) AIDS events and 26 (2%) deaths occurred overtime. Mortality rates decreased from 0.4/100 person-years in 2001–2006 to 0.27/100 person-years in 2007–2012 and 0.07/100 person-years in 2013–2018. Notably, 92% of the dead children were born in Italy, but only 50% were followed-up since birth or within three months of age. Seventy three percent of children had started cART at age ≥6 months; 23% were treated for <30 days before death. B and C clinical events progressively decreased (P < 0.0001). Opportunistic infections significantly decreased over time, but still were the most common events in all the periods (6.76/100 person-years in 2013–2018). In the last period, severe bacterial infections were the most common ones. Cancer rates were 0.07/100; 0.17/100; 0.07/100 person-years in the three periods, respectively. Conclusions: Progressive reductions both in mortality and in rates of class B and C clinical events and OIs have been observed during the cART era. However, deaths were still registered; more than half of dead children were enrolled after birth and had belatedly started cART.
Data stato definitivo:	2022-02-27T14:24:52Z
Appare nelle tipologie:	1.01 Articolo in rivista

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