TY - JOUR
T1 - Impact of sickle cell disease on presentation and progression of paediatric HIV
T2 - a retrospective cohort study
AU - Ssenyondwa, Joseph
AU - George, Paul E.
AU - Carlos Bazo-Alvarez, Juan
AU - Mercedes, Rebecca
AU - Kanywa, Jacqueline B.
AU - Naturinda, Ernest
AU - Wasswa, Peter L.M.
AU - Lubega, Joseph
N1 - Funding Information:
PEG was supported by Texas Children’s Hospital, Houston, Texas. JCBA was funded by Universidad Católica Los Angeles de Chimbote, Peru. The funders played no role in the draft of the manuscript or decision to submit.
Funding Information:
PEG was supported by Texas Children?s Hospital, Houston, Texas. JCBA was funded by Universidad Cat?lica Los Angeles de Chimbote, Peru. The funders played no role in the draft of the manuscript or decision to submit.
Publisher Copyright:
© 2020 John Wiley & Sons Ltd
PY - 2020/7/1
Y1 - 2020/7/1
N2 - Objectives: HIV and sickle cell disease (SCD) are significant causes of morbidity and mortality in sub-Saharan Africa. Given their separate roles in immune dysregulation, our objective was to characterise the impact that SCD has on the presentation and progression of paediatric HIV. Methods: The study was a retrospective cohort study (study period 2004–2018). Cases of HIV + and SCD-afflicted patients (HIV+/SCD+) were obtained via electronic chart review from a paediatric HIV clinic in Kampala, Uganda and matched 1:3 with HIV + controls without SCD (HIV+/SCD-). Results: Thirty-five HIV+/SCD + subjects and 95 HIV+/SCD- controls were analysed (39% female (51/130), age 3.6 years (SD3.9)). At baseline, WHO clinical stage (64% total cohort Stage III/IV) and nutritional status (9.4% severe acute malnutrition) were similar for both groups, whereas HIV+/SCD + had higher though non-significant baseline CD4 count (1036 (SD713) vs 849 (SD638) cells/microlitre, P = 0.20, two-tailed t-test). There were 19 deaths, 6 (17%) HIV+/SCD + and 13 (14%) HIV+/SCD-, with unadjusted/adjusted models showing no significant difference. Nutritional progression and clinical stage progression showed no significant differences between groups. Kaplan–Meier analysis showed a slower rate of treatment failures in the HIV+/SCD + cohort (P = 0.11, log-rank survival test). Trajectory analysis showed that in the time period analysed, the HIV+/SCD + cohort showed a more rapid rise and higher total CD4 count (P = 0.012, regression analysis). Conclusion: The study suggests that SCD does not adversely affect the progression of HIV in patients on ART. Further, HIV+/SCD + achieved higher CD4 counts and fewer HIV treatment failures, suggesting physiological effects due to SCD might mitigate HIV progression.
AB - Objectives: HIV and sickle cell disease (SCD) are significant causes of morbidity and mortality in sub-Saharan Africa. Given their separate roles in immune dysregulation, our objective was to characterise the impact that SCD has on the presentation and progression of paediatric HIV. Methods: The study was a retrospective cohort study (study period 2004–2018). Cases of HIV + and SCD-afflicted patients (HIV+/SCD+) were obtained via electronic chart review from a paediatric HIV clinic in Kampala, Uganda and matched 1:3 with HIV + controls without SCD (HIV+/SCD-). Results: Thirty-five HIV+/SCD + subjects and 95 HIV+/SCD- controls were analysed (39% female (51/130), age 3.6 years (SD3.9)). At baseline, WHO clinical stage (64% total cohort Stage III/IV) and nutritional status (9.4% severe acute malnutrition) were similar for both groups, whereas HIV+/SCD + had higher though non-significant baseline CD4 count (1036 (SD713) vs 849 (SD638) cells/microlitre, P = 0.20, two-tailed t-test). There were 19 deaths, 6 (17%) HIV+/SCD + and 13 (14%) HIV+/SCD-, with unadjusted/adjusted models showing no significant difference. Nutritional progression and clinical stage progression showed no significant differences between groups. Kaplan–Meier analysis showed a slower rate of treatment failures in the HIV+/SCD + cohort (P = 0.11, log-rank survival test). Trajectory analysis showed that in the time period analysed, the HIV+/SCD + cohort showed a more rapid rise and higher total CD4 count (P = 0.012, regression analysis). Conclusion: The study suggests that SCD does not adversely affect the progression of HIV in patients on ART. Further, HIV+/SCD + achieved higher CD4 counts and fewer HIV treatment failures, suggesting physiological effects due to SCD might mitigate HIV progression.
KW - Africa
KW - CD4
KW - HIV
KW - paediatric
KW - sickle cell disease
KW - Uganda
UR - http://www.scopus.com/inward/record.url?scp=85084497622&partnerID=8YFLogxK
U2 - 10.1111/tmi.13408
DO - 10.1111/tmi.13408
M3 - Article
C2 - 32329120
AN - SCOPUS:85084497622
SN - 1360-2276
VL - 25
SP - 897
EP - 904
JO - Tropical Medicine and International Health
JF - Tropical Medicine and International Health
IS - 7
ER -