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Sleep disturbances in a cohort of HIV-infected children and adolescents on antiretroviral treatment: NeuroCoRISpeS
ResumenBackground: Sleep disorders have been reported in adults with HIV infection with a prevalence of at least 30%. Sleep quality (SQ) is very important in children and their daily functioning, although in HIV pediatric population scarce data are avalaible. Our objective was to assess SQ in our cohort and to determine the impact of antiretroviral therapy (ART). Methods: HIV infected children and adolescents due to vertical transmission between 4 and 23 years old. They belonged to a national cohort (CoRISpeS) and were followed according to a standard protocol in several hospitals in Spain. Clinical characteristics, ART and adherence were registered. SQ was assessed through Pittsburgh Sleep Quality Index (PSQI), a questionnaire validated in Spanish population which assesses SQ and disturbances over a month. It scores for 7 components and one global score, distinguishing between good and poor sleepers. For the analysis, we divided the sample into two groups according to the treatment they were receiving (NRTI+NNRTI vs NRTI+PI) in order to assess the influence of ART profile. Univariate and multivariate analysis (logistic regression) were performed. Results: 59 patients were evaluated. Median age: 16y (4,23), age at start of ART: 0.62y (0,14), 66% females, 63% caucasian, AIDS CDC category: 33.9% (13.6% encephalopathy). Median CD4 at baseline: 35% (1,59), CD4/CD8 1.0 (0,3.28), nadir CD4: 15% (0.5,45). Viral load <50cop/ml: 84.7%. Median time on HAART: 11.32 years (0.51,17). The most frequent regimen was 2NRTI+1NNRTI (46%, Efavirenz 43.9%), followed by 2 NRTI+1PI (41%). Good adherence: 83%. No differences were found in clinical and immunovirological variables or time of exposure to ART between both groups. We found poor SQ in 24%, being the most frequent complaints: Sleep disturbances (76.3%), Sleep latency (59.3%), Subjective SQ (57.6%) and Daytime dysfunction (51.8%). There were relationship between the use of NNRTI and Sleep latency (p=.006) and Habitual sleep efficiency (p=.031). Specifically, patients who took EFV presented longer sleep latency (p=.026). Age was also related to poorer SQ (p=.005). When we adjusted the analysis for age, relationship between the use of NNRTI and poorer SQ remained: Sleep latency (p=.027) and Efficiency (p=.088). Conclusions: In our cohort sleep complaints are common. Mainly NNRTI and EFV seem to have an impact on SQ compared to PI regimens. We consider these results important in pediatric population due to the influence in daily functioning, school and cognitive performance.
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- Póster presentado en la CROI 2017, celebrada en Seattle (Estados Unidos) del 13 al 16 de febrero de 2017.