Growth and CD4 patterns of adolescents living with perinatally acquired HIV worldwide, a CIPHER cohort collaboration analysis.

INTRODUCTION Adolescents living with HIV are subject to multiple co-morbidities, including growth retardation and immunodeficiency. We describe growth and CD4 evolution during adolescence using data from the Collaborative Initiative for Paediatric HIV Education and Research (CIPHER) global project. METHODS Data were collected between 1994 and 2015 from 11 CIPHER networks worldwide. Adolescents with perinatally acquired HIV infection (APH) who initiated antiretroviral therapy (ART) before age 10 years, with at least one height or CD4 count measurement while aged 10-17 years, were included. Growth was measured using height-for-age Z-scores (HAZ, stunting if <-2 SD, WHO growth charts). Linear mixed-effects models were used to study the evolution of each outcome between ages 10 and 17. For growth, sex-specific models with fractional polynomials were used to model non-linear relationships for age at ART initiation, HAZ at age 10 and time, defined as current age from 10 to 17 years of age. RESULTS A total of 20,939 and 19,557 APH were included for the growth and CD4 analyses, respectively. Half were females, two-thirds lived in East and Southern Africa, and median age at ART initiation ranged from 7 years in sub-Saharan African regions. At age 10, stunting ranged from 6% in North America and Europe to 39% in the Asia-Pacific; 19% overall had CD4 counts <500 cells/mm3 . Across adolescence, higher HAZ was observed in females and among those in high-income countries. APH with stunting at age 10 and those with late ART initiation (after age 5) had the largest HAZ gains during adolescence, but these gains were insufficient to catch-up with non-stunted, early ART-treated adolescents. From age 10 to 16 years, mean CD4 counts declined from 768 to 607 cells/mm3 . This decline was observed across all regions, in males and females. CONCLUSIONS Growth patterns during adolescence differed substantially by sex and region, while CD4 patterns were similar, with an observed CD4 decline that needs further investigation. Early diagnosis and timely initiation of treatment in early childhood to prevent growth retardation and immunodeficiency are critical to improving APH growth and CD4 outcomes by the time they reach adulthood

Reagan's "Gender Gap" Strategy and the Limitations of Free-Market Feminism

In late November 1982, presidential aide Lee Atwater forwarded to chief of staff James Baker a report warning about “one of the most severe challenges facing the [Reagan] administration” in the coming year, one that “could lock the GOP into permanent minority status.” He was referring to the “gender gap”: women had voted for Reagan in significantly lower proportions than men, Reagan’s approval lagged among women, and pundits credited women voters with several Democratic victories in the 1982 midterm elections. Polls also showed potential presidential contenders for 1984 running “substantially better among women than men in trial heats with President Reagan.” Pollster Ronald Hinckley counseled that “continued growth of the gender gap . . . could cause serious trouble for Republicans in 1984,” while California congresswoman Bobbie Felder warned that the gender gap could prove “disastrous.” Media analysts contributed to Republican alarm. Adam Clymer speculated in the New York Times that the gender gap “may infl uence American life in the 1980s as much as the civil rights revolution did in the 1960s.”Keywords: Political Science, Histor

Long-term trends in mortality and AIDS-defining events after combination ART initiation among children and adolescents with perinatal HIV infection in 17 middle- and high-income countries in Europe and Thailand: A cohort study

Background Published estimates of mortality and progression to AIDS as children with HIV approach adulthood are limited. We describe rates and risk factors for death and AIDS-defining events in children and adolescents after initiation of combination antiretroviral therapy (cART) in 17 middle-and high-income countries, including some in Western and Central Europe (W&amp;CE), Eastern Europe (Russia and Ukraine), and Thailand. Methods and findings Children with perinatal HIV aged &lt; 18 years initiating cART were followed until their 21st birthday, transfer to adult care, death, loss to follow-up, or last visit up until 31 December 2013. Rates of death and first AIDS-defining events were calculated. Baseline and time-updated risk factors for early/late (&lt;=/&gt; 6 months of cART) death and progression to AIDS were assessed. Of 3,526 children included, 32% were from the United Kingdom or Ireland, 30% from elsewhere in W&amp;CE, 18% from Russia or Ukraine, and 20% from Thailand. At cART initiation, median age was 5.2 (IQR 1.4-9.3) years; 35% of children aged &lt; 5 years had a CD4 lymphocyte percentage &lt; 15% in 1997-2003, which fell to 15% of children in 2011 onwards (p &lt; 0.001). Similarly, 53% and 18% of children &gt;= 5 years had a CD4 count &lt; 200 cells/mm(3) in 1997-2003 and in 2011 onwards, respectively (p &lt; 0.001). Median follow-up was 5.6 (2.9-8.7) years. Of 94 deaths and 237 first AIDS-defining events, 43 (46%) and 100 (42%) were within 6 months of initiating cART, respectively. Multivariable predictors of early death were: being in the first year of life; residence in Russia, Ukraine, or Thailand; AIDS at cART start; initiating cART on a nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimen; severe immune suppression; and low BMI-for-age z-score. Current severe immune suppression, low current BMI-for-age z-score, and current viral load &gt; 400 c/mL predicted late death. Predictors of early and late progression to AIDS were similar. Study limitations include incomplete recording of US Centers for Disease Control (CDC) disease stage B events and serious adverse events in some countries; events that were distributed over a long time period, and that we lacked power to analyse trends in patterns and causes of death over time. Conclusions In our study, 3,526 children and adolescents with perinatal HIV infection initiated antiretroviral therapy (ART) in countries in Europe and Thailand. We observed that over 40% of deaths occurred &lt;= 6 months after cART initiation. Greater early mortality risk in infants, as compared to older children, and in Russia, Ukraine, or Thailand as compared to W&amp;CE, raises concern. Current severe immune suppression, being underweight, and unsuppressed viral load were associated with a higher risk of death at &gt; 6 months after initiation of cART

Characteristics of children overall, and by timing of death, for those who died.

<p>Characteristics of children overall, and by timing of death, for those who died.</p

Rates of AIDS-defining events among children with no previous AIDS diagnosis at initiation of cART, <i>N</i> = 2,863.

<p>Rates of AIDS-defining events among children with no previous AIDS diagnosis at initiation of cART, <i>N</i> = 2,863.</p