24-month clinical, immune-virological outcomes and HIV status disclosure in adolescents living with perinatally-acquired HIV in the COHADO cohort, in Togo and Côte d’Ivoire, 2015-2017

Abstract Background: Adolescents living with perinatally-acquired HIV (APHIV) face challenges including the disclosure of their HIV-serostatus that we explored in the West-African COHADO cohort. We assessed the 24-month outcomes among APHIV in relation to the disclosure of their own HIV-serostatus.Methods: Nested within the International epidemiologic Database to Evaluate AIDS pediatric West African prospective cohort (IeDEA pWADA), the COHADO cohort included antiretroviral (ART)-treated APHIV aged 10–19 years, enrolled in HIV-care <10 years, in Abidjan (Côte d’Ivoire) and Lomé (Togo) in 2015. An unfavorable outcome was defined when either death, loss to follow-up, progression to WHO-AIDS stage, a decrease of CD4 count >10% compared to baseline, or a detectable viral load (>50copies/mL) were notified at 24 months. None of these events defined a favorable outcome. We investigated correlates of APHIV favorable 24-month outcome using a logistic regression model.Results: Overall, 209 APHIV were included, 51.6% in Abidjan, 54.5% were females. At inclusion, median CD4 cell count was 521/mm3 (IQR[281-757]); 29.6% had a VL measurement of whom 3.2% in virological suppression. APHIV were younger in Lomé (median age: 12 years (interquartile range [IQR]:11-15) compared to Abidjan (14 years (IQR:12-15, p=0.01). Full HIV-disclosure increased from 41.6% at inclusion to 74.1% after 24 months. After 24 months of follow-up, 6 (2.9%) died, 8 (3.8%) were lost to follow-up, 4 (1.9%) were transferred out. Overall, 73.7% did not progress to WHO-AIDS stage, 62.7% had CD4 count above (± 10%) of the baseline value (48.6% in Abidjan versus 69.0% in Lomé, p<0.001). Among the 83.7% with VL measurements, 48.8% were in virological suppression (Abidjan: 45.4%, Lomé: 52.5%, p<0.01). The 24-month combined outcome was favorable for 45% (29.6% in Abidjan and 61.4% in Lomé, p<0.01): adjusted on baseline variables, it was not significantly associated with HIV-disclosure but significantly higher for APHIV living in Lomé compared to those in Abidjan (aOR: 17.24, 95%CI [3.69-80.44]).Conclusions: 24-month favorable outcome rates were low among West-African APHIV and differed across countries. HIV-disclosure frequency improved over time but remained low. Context-specific responses are urgently needed to improve adolescent’s care to reach the UNAIDS 90% target of virological success for those on ART.