Chappell, E;
Group Authorship: The European Pregnancy and Paediatric Infectio;
(2021)
Malignancies among children and young people with HIV in Western and Eastern Europe and Thailand.
AIDS
10.1097/QAD.0000000000002965.
(In press).
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Abstract
OBJECTIVES: Investigate trends over time and predictors of malignancies among children and young people with HIV. DESIGN: Pooled data from 17 cohorts in 15 countries across Europe and Thailand. METHODS: Individuals diagnosed with HIV and presenting to paediatric care <18 years of age were included. Time at risk began at birth for children with documented vertically-acquired HIV, and from first HIV-care visit for others. Children were followed until death, loss-to-follow-up, or last visit in paediatric or adult care (where data after transfer to adult care were available). Rates of reported malignancies were calculated overall and for AIDS-defining malignancies (ADM) and non-AIDS-defining malignancies (NADM) separately. Risk factors for any malignancy were explored using Poisson regression, and for mortality following a malignancy diagnosis using Cox regression. RESULTS: Among 9,632 individuals included, 140 (1.5%) were ever diagnosed with a malignancy, of which 112 (80%) were ADM. Overall, the rate of any malignancy was 1.18 per 1,000 person-years; the rate of ADM decreased over time while the rate of NADM increased. Male sex, being from a European cohort, vertically-acquired HIV, and current severe immunosuppression, viral load >400 copies/mL, older age and, for those not on treatment, earlier calendar year, were risk factors for a malignancy diagnosis. 58 (41%) of individuals with a malignancy died, a median 2.4 months (IQR 0.6, 8.8) after malignancy diagnosis. CONCLUSION: The rate of ADM has declined since widespread availability of combination ART, although of NADM there was a small increase. Mortality following a malignancy was high, warranting further investigation.
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