Impact of sickle cell disease on presentation and progression of paediatric HIV: a retrospective cohort study.
OBJECTIVES
HIV and sickle cell disease (SCD) are significant causes of morbidity and mortality in sub-Saharan Africa. Given their separate roles in immune dysregulation, our objective was to characterise the impact that SCD has on the presentation and progression of paediatric HIV.


METHODS
The study was a retrospective cohort study (study period 2004-2018). Cases of HIV + and SCD-afflicted patients (HIV+/SCD+) were obtained via electronic chart review from a paediatric HIV clinic in Kampala, Uganda and matched 1:3 with HIV + controls without SCD (HIV+/SCD-).


RESULTS
Thirty-five HIV+/SCD + subjects and 95 HIV+/SCD- controls were analysed (39% female (51/130), age 3.6 years (SD3.9)). At baseline, WHO clinical stage (64% total cohort Stage III/IV) and nutritional status (9.4% severe acute malnutrition) were similar for both groups, whereas HIV+/SCD + had higher though non-significant baseline CD4 count (1036 (SD713) vs 849 (SD638) cells/microlitre, P = 0.20, two-tailed t-test). There were 19 deaths, 6 (17%) HIV+/SCD + and 13 (14%) HIV+/SCD-, with unadjusted/adjusted models showing no significant difference. Nutritional progression and clinical stage progression showed no significant differences between groups. Kaplan-Meier analysis showed a slower rate of treatment failures in the HIV+/SCD + cohort (P = 0.11, log-rank survival test). Trajectory analysis showed that in the time period analysed, the HIV+/SCD + cohort showed a more rapid rise and higher total CD4 count (P = 0.012, regression analysis).


CONCLUSION
The study suggests that SCD does not adversely affect the progression of HIV in patients on ART. Further, HIV+/SCD + achieved higher CD4 counts and fewer HIV treatment failures, suggesting physiological effects due to SCD might mitigate HIV progression.
['Ssenyondwa|Joseph|J|', 'George|Paul E|PE|', 'Carlos Bazo-Alvarez|Juan|J|', 'Mercedes|Rebecca|R|', 'Kanywa|Jacqueline B|JB|', 'Naturinda|Ernest|E|', 'Wasswa|Peter L M|PLM|', 'Lubega|Joseph|J|']
D000293:Adolescent D000755:Anemia, Sickle Cell D019380:Anti-HIV Agents D018791:CD4 Lymphocyte Count D002648:Child D002675:Child, Preschool D018450:Disease Progression D005260:Female D015658:HIV Infections D006801:Humans D007223:Infant D007231:Infant, Newborn D008297:Male D012189:Retrospective Studies D012307:Risk Factors D016019:Survival Analysis D014454:Uganda
sickle cell disease paediatric HIV Africa Uganda CD4 Afrique Ouganda VIH drépanocytose pédiatrie