A Retrospective Descriptive Study of Immunological and Virological Profiles of Adults Who Acquired Hiv in Childhood Through Mother-to-child Transmission

Abstract

Background: To provide optimal targeted interventions, it is important to describe the virological and immunological profiles across all subgroups of people living with HIV (PLWH). This includes special groups like adults who contracted HIV through mother-to-child transmission (MTCT). Such individuals usually acquire HIV in childhood when their immune systems are immature and still developing. The ability of the virus to adapt and evolve within the host's body in childhood, and potential viral variations, could all lead to a unique viral dynamics and modulate the course of the disease even later in adulthood. This contrasts with adults who contract HIV through other routes, such as sexual contact or intravenous drug use, where their immune systems are typically more developed. Yet, adults who contracted HIV through MTCT are understudied. Studying their immunological and virological profiles could inform optimization of their treatment Programmes. Methods: To characterize the immunological and virological profiles of ART-treated adults who acquired HIV through MTCT, we conducted a retrospective study on secondary data that were collected from HIV-infected adults who were registered in Children of God Relief Institute (COGRI) in childhood. To maximize the study's statistical power, the study included all the COGRI participants who had their immunological and or virological profiles done in the year 2018; HIV Viral load, CD4 T cell counts, lymphocyte count, neutrophils count, and monocytes counts were retrieved from the laboratory information system. Data on potential predictors of immunological and virological failure were also retrieved, namely age, Aspartate aminotransferase (AST), Alanine aminotransferase (ALT) and opportunistic infections-tuberculosis and Cryptococcal meningitis. Results: Viral load suppression at <1,000 copies/mL was 73% (479 of 652) in ART-treated adults who acquired HIV in adulthood through MTCT, lower than that previously reported in ART-treated adults in the general population (90.6%). The median for CD4 T cell counts was 569 cells/mm3. Median percentages for neutrophils, lymphocytes and monocytes were 45%, 45%, 5.5 %, respectively. The median AST and ALT levels were 24.45 IU/L and 17.6 IU/L, respectively. Participants who had detectable viremia (>1,000 copies/mL) also had lower CD4 counts (P<0.001), lower percentages of lymphocytes (p=0.024) and higher percentages of monocytes (P<0.001) when compared to those who were viremically suppressed (=/<1,000 copies/mL). There were also notable inverse correlations between ALT and viral loads (Rho= -0.11, p<0.05) as well as between AST and CD4 counts (Rho= -0.12, p<0.05). Page 6 of 60 Discussion:The study underscores the distinct challenges faced by adults who acquired HIV through MTCT, emphasizing their unique immunological and virological profiles and the implications for their long-term health outcomes. Understanding these unique profiles is crucial for developing targeted interventions and treatment strategies that address the specific needs of this population, ultimately improving their quality of life and reducing the burden of HIV/AIDS. These differences, particularly the lower rates of viral load suppression, underscore the need for tailored treatment approaches. The disparities between this subgroup and the general adult population highlight potential gaps in our understanding and management of HIV in those with childhood-acquired infection. Conclusion: ART-treated adults who acquired HIV in childhood through MTCT have lower rates of viral load suppression when compared to ART-treated adults who acquired HIV in adulthood. The resultant poor viral load suppression is associated with decreased CD4 counts, lowered percentages of lymphocytes and elevated percentages of monocytes, suggestive of compromised immune system and immune activation. The study suggests clinicians should monitor and tailor therapeutic interventions for adults with HIV acquired through MTCT, with further research to understand underlying mechanisms. Health systems should prioritize capacity-building initiatives and training to improve care for these unique individuals