Long-term outcomes of children treated for HIV-infection

Despite the drastic decrease of mortality and morbidity since the introduction of combination antiretroviral therapy (cART) in 1996, children with a chronic HIV-infection remain vulnerable to multiple complications that may negatively impact their physical health, cognitive function and psychological wellbeing. The first part of this thesis focuses on HIV-infected children in care in the Netherlands since 1996. The majority of these children are immigrants from sub-Saharan Africa. They had a sustained long-term immunological reconstitution, which was independent of age at cART-initiation. The percentage of treated children with an undetectable HIV viral load rose substantially over time, and mortality rate was low as compared to other industrialized countries.
Part 2 addresses various complications of chronic HIV-infection in children. We found that the cognitive performance of HIV-infected children was poorer as compared to a group of age-, gender-, ethnicity- and socioeconomically-matched controls. Neuroimaging showed that the HIV-infected group had a lower cortical and white matter volume, more white matter hyperintensities and poorer white matter integrity. A thinner retinal fovea was found in the HIV-infected children, however visual function was not affected. No decline in health-related quality of life was found. Lastly, we showed that subcutaneous fat loss is still prevalent in children treated for HIV, and is strongly associated with the antiretroviral drug stavudine; which although eliminated from treatment protocols is still often prescribed in developing countries where alternatives are sparse.
Future research in HIV-infected children should focus on pathophysiology behind the detected complications, and ultimately lead to their treatment and prevention.