Clinics in Mother and Child Health

Causes of Hospitalizations in Adolescents Infected with HIV and on ARV Treatment in a Pediatric Ward in Ouagadougou

Yonaba Okengo C^1*, Kalmogho Zan Angèle¹, Toguyeni Tamini F², Sawadogo A¹, Zoungrana C¹, Ouédraogo F¹, Ouédraogo S², Dao L², Kyelem J¹, Koueta F¹, Yé D² and Okeng’O K^{1 1}Department of Pediatrics, CHU Yalgado Ouédraogo Ouagadougou, Burkina Faso
²Department of Medical Paediatrics, CHU Paediatrics Charles de Gaulle, Ouagadougou, Burkina Faso
^*Correspondence: Yonaba Okengo C, Department of Pediatrics, CHU Yalgado Ouédraogo Ouagadougou, Burkina Faso, Email:

Received: 01-Mar-2022, Manuscript No. CMCH-22-15779; Editor assigned: 04-Mar-2022, Pre QC No. CMCH-22-15779(PQ); Reviewed: 17-Mar-2022, QC No. CMCH-22-15779; Revised: 25-Mar-2022, Manuscript No. CMCH-22-15779(R); Published: 01-Apr-2022, DOI: 10.35248/2090-7214.22.19.400

Introduction

Annual deaths related to HIV infection have decreased for all age groups except for adolescents (10 to 19 years) for whom mortality has more than doubled in recent years [1]. In 2016, West and Central Africa regions recorded a 15% increase in the annual number of HIV-related deaths in adolescents despite globally progress in the fight against this pandemic [2,3]. Moreover, in countries like Burkina Faso, the situation of ALHIV is not well known. What more, data by age groups rarely individualize adolescents as a group, in spite of the well-known fact that this period of life can be very difficult especially for those living with HIV. Hence, adherence to Antiretroviral Treatment (ART) is in most cases a challenge, this contributes to the delay in attaining UN AIDS objective i.e., 95% of people on ARVs should have an undetectable viral load by 2030 [4-6]. In addition, ARV treatment has been associated with high prevalence of non-communicable diseases such as arterial hypertension, type 2 diabetes, kidney and liver diseases in the long term [7-11].

The objective of our study was to analyze causes of morbidity among adolescents on ART hospitalized in the pediatric department of CHU Yalgado Ouédraogo (CHU YO).

Methodology

This was a descriptive and analytical retrospective study on adolescents aged 10 to 19 years on antiretroviral treatment for at least 6 months, followed in the pediatric department of the CHU Yalgado Ouédraogo from January 2008 to December 2018. CHU Yalgado Ouédraogo is one of the main referral hospitals in the country for the care of HIV infected children and adolescents.

We used medical records as well as consultation and hospitalization registers. For each adolescent were included data upon study inclusion and hospitalization as follows: Sociodemographic (age, sex, location, schooling, and social status of parents), clinical characteristics (date of HIV diagnosis, circumstances of diagnosis, medical and surgical history, WHO clinical stage, anthropometric parameters and indices, etc), biological data (hemoglobin level, TCD4 lymphocyte level, viral load). Anemia was considered if the hemoglobin level was less or equal to 10 g/dl.

Data were analyzed using the EPI INFO software version 7.2.1.0. For the comparison of qualitative variables, we used Chi-square and Fischer's exact tests when sample was less than five (significance threshold p ≤ 0.05). Variables with a p-value<0.20 were introduced in a logistic regression model for the multivariate analysis.

Results

Sample description

We included 158 adolescents, among them 15 (9.2%) had been hospitalized at least once since the diagnosis of HIV. The mean age at the time of diagnosis of HIV was 4.9 years [extremes 2 months and 14 years]. The mean age at enrollment was 13.6 years [extremes 10 and 19 years] with 82 (51.9%) adolescents less than 13 years old, and 15.2% over 17 years old. The sex ratio was 1.1. Adolescents were orphan of at least one parent in 29.8% of cases. HIV transmission was perinatally in 96.2%. Substantial academic difficulties were noted in 19 (31.2%) of the 141 adolescents attending school.

ARV treatment was initiated during adolescence in 19.6%. History of pulmonary tuberculosis was noted in nine adolescents. HbS antigen was positive in two adolescents and severe immunosuppression was observed in 77 (48.8%). Other main characteristics of the population are shown in Table 1.

Table 1: Characteristics of ALHIV on ARV in CHUYO from 2008-2018.

Causes of hospitalization and associated factors in ALHIV

Fifteen teenagers had a history of at least one hospitalization. The mean duration of hospital stay was 12.3 days [extreme 4 and 32 days]. Two adolescents aged between 17 and 19 were informed of their HIV positive status. The nutritional status was specified in 14 adolescents. Among them 9/14 had severe acute malnutrition and 2/14 had moderate acute malnutrition. Anemia was present in 14/15. LTCD4 and viral load rates were available in respectively 11 and 9 patients: LTCD4 rate ≤ 200 cells/ml in seven and Viral load ≥ 1000 copies/ml in six adolescents. Table 2 summarizes the reasons for hospitalization and final diagnostic during hospitalization.

Table 2: Causes of hospitalization and diagnostics in fifteen HIV infected adolescents hospitalized from January 2008 to December 2018 at CHUYO.

In multivariate analysis, optimal treatment adherence (OR=0.06 [0.007;0.57]; p=0.005) and WHO clinical stage 3 to 4 (OR=26.7 [4.97;143.27]; p<0.001) were significantly associated with morbidity.

Discussion

Sample characteristics

The majority of ALHIV live in constraints conditions, thus one in three has learning problems at school (31.2%) and a third are (29.8%) orphans. The diagnosis of HIV infection in this population was quite late (4.9 years), this is still the case in most of sub-Sahara Africa [12] where HIV screening in children remains very low [13].

The impact of early ART initiation in reducing morbidity and mortality is well known [14-16]. However, little has been written about long-term effects of co-morbidities such as severe acute malnutrition [17]. For some authors, acute malnutrition at early age can reduce very significantly the chances for growth and immunity restauration, due to increased microbial translocation and systemic activation of altered LTCD4 [18,19].

Causes of hospitalization and associates factors

Hospitalization concerned 15 ALHIV. In South Africa, a multicenter study noted higher hospitalization incidence in HIV positive adolescents [OR 6.6 (95% CI:5.7-7.8)] compared to HIV negative [OR=2.2; 95% CI:1.2-4.3)] with (p=<0.01) [20]. Lower hospitalization incidence rate in our study is likely due to the small sample size and the fact that our unity wasn’t admitting patients with surgical and mental health issues. Causes of hospitalization were dominated by infectious diseases (79.7% of hospitalizations), unlike Frigat's study in which non-infectious diseases (90/515 cases) dominated hence hearing disorders (28%) and surgical pathologies (19%) [20]. In addition for Frigat, tuberculosis concerned 41.7% of infection cases while it concerned a much smaller population in our study. This could be because in Burkina Faso tuberculosis in adolescents is still largely underdiagnosed, and the population of HIV infected adolescents is small compared to that of South Africa, one of the most affected countries in Africa [20]. The key to reducing tuberculosis-related mortality among ALHIV remains prevention through early diagnosis, improved hygiene, vaccination and prophylaxis [21,22].

Worldwide, highly effective ARV treatment and cotrimoxazole prophylaxis have reduced tremendously the incidence of other infections such as infectious gastroenteritis. However for patients experiencing ARV treatment failure (7/11 of our hospitalized patients), gastroenteritis especially of parasite origin remain life threating in severe immunosuppression condition. As for non-infectious gastroenteritis, they are often underdiagnosed in resource limited setting and are most likely due to drug toxicity.

Two factors were significantly associated with hospitalization in ALHIV, namely poor ARV treatment adherence and severe acute malnutrition. Severe acute malnutrition in ALVIH with persistent ARV treatment failure is of poor prognosis and as such must be managed accordingly.

Conclusion

The limitations of this study are related to its retrospective nature and the small sample size. Thus, we could not compare our patients with a control group of HIV-uninfected adolescents. Furthermore, the scale of non-communicable diseases seemingly alarming in the region could not be assessed.

Causes of hospitalization among ALHIV are preventable. There is an urgent need for more reliable diagnosis tests for those diseases which contribute largely to high morbidity and mortality rate in ALHIV. Maintaining optimum ARV treatment adherence remains a challenge in ALHIV.

Conflict of Interest

None

Ethical Standards

The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national guidelines and has been approved by the Ethics Committee of CHU Yalgado Ouédraogo.

REFERENCES

1. UNAIDS. Ending the AIDS epidemic for adolescents, with adolescents. 2020.

   [Cross ref]

2. UNICEF. Picking up the pace: Towards an AIDS-free generation in West Africa and Centrale, Dakar. 2017.

   [Cross ref]

3. OMS. Health for the world's adolescents, a second chance for the second decade. 2019.

   [Cross ref]

4. Kariminia A, Law M, Davies MA, Vinikoor M, Wools‐Kaloustian K, Leroy V, et al. Mortality and losses to follow‐up among adolescents living with HIV in the IeDEA global cohort collaboration. J Int AIDS Soc. 2018;21(12):e25215.

   [Cross ref] [Google scholar]

5. WHO. What’s new in adolescent treatment and care. 2019.

   [Cross ref]

6. Frigati LJ, Ameyan W, Cotton MF, Gregson CL, Hoare J, Jao J, et al. Chronic comorbidities in children and adolescents with perinatally acquired HIV infection in sub-Saharan Africa in the era of antiretroviral therapy. Lancet Child Adolesc Health. 2020;4:688-698.

   [Cross ref] [Google scholar] [Pubmed]

7. Frigati L, Sana M, Nourse P, Ray P, Perrazzo S, Machemedze T, et al. Prevalence of risk factors for chronic kidney disease in South African youth with perinatally acquired HIV. Pediatr Nephrol. 2019;34(2):313-318.

   [Cross ref] [Google scholar] [Pubmed]

8. Chatterton-Kirchmeier S, Camacho-Gonzalez AF, McCracken CE, Chakraborty R, Batisky DL. Increased prevalence of elevated blood pressures in HIV-infected children, adolescents and young adults. Pediatr Infect Dis J. 2015;34(6):610-614.

   [Cross ref] [Google scholar] [Pubmed]

9. Beng H, Rakhmanina N, Moudgil A, Tuchman S, Ahn S-Y, Griffith C, et al. HIV-associated CKDs in children and adolescents. Kidney Int Rep. 2020;5;2292-2300.

   [Cross ref] [Google scholar] [Pubmed]

10. Frigati LJ, Brown K, Mahtab S, Githinji L, Gray D, Zuhlke L, et al. Multisystem impairment in South African adolescents with perinatally acquired HIV on Antiretroviral Therapy (ART). J Int AIDS Soc. 2019;22:e25386.

    [Cross ref] [Google scholar] [Pubmed]

11. Rukuni R, Rehman AM, Mukwasi-Kahari C, Madanhire T, Kowo-Nyakoko F, McHugh G, et al. Effect of HIV infection on growth and bone density in peripubertal children in the era of antiretroviral therapy: A cross-sectional study in Zimbabwe. Lancet Child Adolesc Health. 2021;5:569-581.

    [Cross ref] [Google scholar] [Pubmed]

12. Dvora JD, Kristin MW, Claire S, Marlien P, Madaline F, Ntokozo M. Positivity and referral to treatment following index testing of partners and children of HIV-infected patients in public sector facilities in South Africa. J Acquir Immune Defic Syndr. 2019;81(4):365–370.

    [Google scholar][Pubmed]

13. Mwadianvita C, Ilunga E, Djouma J, Wembonyama C, Amutomb F, Ekwalanga M, et al. Study of anemia in HIV-positive children naïve to antiretroviral treatment in Lubumbashi, Democratic Republic of Congo. Pan Afric Med Jour. 2014;17(1):1-5.

    [Cross ref] [Google scholar] [Pubmed]

14. Yonaba C, Kalmogho A, Ouédraogo A, Zoungrana C, Ouédraogo S, Ouédraogo F, et al. Evolution of anemia in children on antiretroviral treatment at the CHU Yalgado Ouédraogo. Science and technology. Health sciences. 2016;39(1):125-133.

    [Cross ref]

15. WHO. Tuberculosis decline in populations affected by HIV: A retrospective study of 12 countries in the WHO African Region Christopher Bull World Health Organ. 2019;97:405-414.

    [Google scholar] [Pubmed]

16. Dewey KG, Begum K. Long-term consequences of stunting in early life. Matern Child Nutr. 2011;7(3):5-18.

    [Cross ref] [Google scholar] [Pubmed]

17. Paige Williams L, Jesson J. Growth and pubertal development in HIV-infected adolescents. Curr Opin HIV AIDS. 2018;13(3):179-186.

    [Cross ref] [Google scholar] [Pubmed]

18. Muenchhoff M, Healy M, Singh R, Roider J, Groll A, Kindra C, et al. Malnutrition in HIV-infected children is an indicator of severe disease with an impaired response to antiretroviral therapy. Aids Res Human Retroviruses. 2018;34(1):46-55.

    [Cross ref] [Google scholar] [Pubmed]

19. Frigati L, Brown K, Cotton MF, Myer L, Zar H. Hospitalization in South African adolescents with perinatally-acquired HIV on antiretroviral therapy. Pediatr Infect Dis J. 2020;39(11): 1035-1039.

    [Cross ref] [Google scholar] [Pubmed]

20. Rüsch-Gerdes S, Hilleman D. Modern laboratory diagnostics for mycobacteria. Pneumol. 2008;62(9):533-540.

    [Cross ref] [Pubmed]

21. Zunza M, Gray DM, Young T, Cotton M, Zar HJ. Isoniazid for preventing tuberculosis in HIV-infected children (Review). Cochrane Database. Syst Rev. 2017;29(8):CD006418.

    [Cross ref]

22. Abange WB, Nkenfou CN, Gonsu Kamga H, Nguedia CA, Kamgaing N, Lozupone C, et al. Intestinal parasites infections among HIV infected children under antiretrovirals treatment in Yaoundé, Cameroon. J Trop Pediatr. 2020;66(2):178-218.

    [Cross ref] [Google scholar] [Pubmed]