Prevalence and factors associated with delayed puberty among adolescents on boosted protease inhibitor based second line art at PIDC

Abstract

Background: Delayed puberty is a recognised feature of children infected with Human Immunodeficiency Virus type 1 (HIV-1) infection. Pubertal maturation contributes to sexual attitudes, social acceptance and to the general wellbeing of an HIV-infected adolescent. However, this is also inadvertently affected by the long-term medication, increased nutritional demands and other medical complications including the inherent effect of HIV virus on the body. There is need for evaluating the effect of second line drugs such as boosted Atazanavir (ATV/r) and Lopinavir (LPV/r) on sexual development among adolescents in low-income countries (LIC) amidst an increasing adolescent population failing on first line Anti-retroviral therapy (ART).

Objectives: To determine the prevalence and factors associated with delayed puberty among adolescents on boosted Protease inhibitor (PI) based second line regimen in an era of readily available ART.

Methodology: We conducted a cross-sectional study among HIV-infected adolescents on boosted ATV/r and LPV/r based regimens receiving care from the Paediatrics Infectious Diseases Clinic (PIDC) at Mulago National Referral Hospital. Two hundred and thirty participants were recruited into the study. A pre-coded questionnaire was used to collect data, entered using Epidata V.3.1 and exported to STATA V14.0 for analysis. Continuous variables were summarized using means and standard deviations while categorical variables were summarized using frequencies and percentages. Chi square tests and logistic regression was used to determine factors associated with delayed puberty at bivariate and multivariate levels respectively.

Results: Majority of the participants enrolled were female, resided in Kampala and were aged between 17 and 19 years of age. The overall prevalence of delayed puberty among HIV infected adolescents on boosted PI based ART attending PIDC was 20/230 (8.7%). Females 13/125 (10.4%) were more affected than males 7/105 (6.7%). Overall estimates of mean age at different Tanner stages for sex were higher than healthy reference populations. Factors independently associated with delayed puberty at multivariate analysis included Age at initiation of ART (AOR=1.372, 95%CI=1.064-1.770, p=0.015) and Body Mass Index For Age Z score (BFAZ) (AOR=7.632,95%CI=1.799-32.380, p= 0.006).

Conclusions and recommendations: Every one in eleven HIV infected adolescents on boosted PI based second line regimen has delayed puberty. Delayed puberty in HIV infected adolescents on boosted PI based second line regimen is highly associated with older age at initiation of ART and wasting. Adequate nutritional monitoring must be extended to HIV infected adolescents in a bid to ensure normal weight and consequently, normal puberty, as well as striving towards universal ART coverage in the paediatric population. Further longitudinal studies to establish biological diagnosis and guide treatment of delayed puberty in this population is needed.