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Long-term risk of hospitalization and chronic disease among children who were HIV-exposed uninfected (cHEU) compared to population controls in Montreal, Canada

Title
Long-term risk of hospitalization and chronic disease among children who were HIV-exposed uninfected (cHEU) compared to population controls in Montreal, Canada
Presenter
Brochon Jeanne
Authors
B. Jeanne * (1), T. Ducruet (1), S. Taillefer (1), M.E. Metras (1), S. Valois (1), V. Lamarre (1), I. Boucoiran (1), H. Soudeyns (1), J. Puyat (2), J. Singer (2), F. Kakkar (1)
Institutions
(1) CHU Sainte Justine, Université de Montréal, Montréal, Canada, (2) CIHR Canadian HIV Clinical trials Network, Vancouver, Canada

BACKGROUND: While studies have demonstrated increased risk of morbidity and mortality among cHEU in early life, the need for specialized follow-up of cHEU once their HIV status has been confirmed negative is not clear. The primary objective of this study was to determine the long-term risk of hospitalization, and incidence of chronic disease, among cHEU compared to HIV-unexposed uninfected (cHUU) controls.
METHODS: Longitudinal cohort study linking data from the Centre Maternel et Infantile sur le SIDA (CMIS) cohort to administrative data from the Régie de l'Assurance Maladie du Quebec (RAMQ), a universal health system with unique single patient identifiers, covering all care services provided. ICD-9 codes were extracted and grouped by system for measures of chronic diseases and cHEU matched 1:3 by age, gender and postal code to cHUU controls. Survival analysis was used to determine risk of hospitalization and chronic disease.
RESULTS: Among 847 cHEU enrolled in the CMIS cohort between 1988 and 2015, 726 were linked to the RAMQ database, and matched to 2178 cHUU. Median follow-up was 11.1 [6.6 ' 15.9] years. There was a significantly higher risk of hospitalization among cHEU vs. cHUU over their life-span (HR 1.42 [1.26 ' 1.61], p<0.001), which remained significant after adjusting for gestational age (aHR 1.23 [1.08 ' 1.40], p=0.001), and in a sensitivity analysis excluding prolonged (>5 days) birth hospitalization (HR 1.21 [1.06 ' 1.41] (Figure 1). Over their lifespan, cHEU had a significantly higher risk of neuropsychiatric disorders (33.3% vs. 26.1%, RR 1.28 [1.13 ' 1.45], p<0.001) and congenital anomalies (5.5%vs. 3.5%, RR 1.58 [1.09 ' 2.3], p=0.016), though there was no difference in risk of chronic cardiovascular, respiratory or neoplastic disease.


CONCLUSIONS: In this resource-rich setting with universal health-care, cHEU had increased risk of hospitalization and neuro-psychiatric disorders, suggesting that cHEU would benefit from enhanced pediatric care, including early neurodevelopmental assessment.