Clinical Outcomes of Adolescents and Young Adults in Adult HIV Care

Ryscavage, Patrick; Anderson, Evan J.; Sutton, Sarah H.; Reddy, Susheel; Taiwo, Babafemi

doi:10.1097/qai.0b013e31822d7564

Cited by 124 publications

(113 citation statements)

References 29 publications

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“…At 1 site, HIV-infected youth aged 17 to 24 years who received care in an adult health clinic had poorer outcomes than did older adults in the same clinic, with lower rates of viral suppression and nearly 4 times the rate of loss to follow-up. 15 However, increases in CD4+ T-lymphocyte counts were similar in the 2 groups. High rates of substance use and mental health problems, difficulties in adjustment, and reduced emotional support may lead to loss to follow-up and disease progression.…”

Section: Introductionmentioning

confidence: 86%

“…High rates of substance use and mental health problems, difficulties in adjustment, and reduced emotional support may lead to loss to follow-up and disease progression. 15,16 In addition, in many states, youth who have received public health insurance coverage become ineligible at 18 to 21 years of age, limiting their access to care and medications. Among HIV-infected youth older than 18 years who transitioned from National Institutes of Health clinical research protocols to adult care, 15% reported not having health insurance.…”

Section: Introductionmentioning

confidence: 99%

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Transitioning HIV-Infected Youth Into Adult Health Care

Chakraborty¹,

Dyke²,

Flynn³

et al. 2013

Pediatrics

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With advances in antiretroviral therapy, most HIV-infected children survive into adulthood. Optimal health care for these youth includes a formal plan for the transition of care from primary and/or subspecialty pediatric/adolescent/family medicine health care providers (medical home) to adult health care provider(s). Successful transition involves the early engagement and participation of the youth and his or her family with the pediatric medical home and adult health care teams in developing a formal plan. Referring providers should have a written policy for the transfer of HIV-infected youth to adult care, which will guide in the development of an individualized plan for each youth. The plan should be introduced to the youth in early adolescence and modified as the youth approaches transition. Assessment of developmental milestones is important to define the readiness of the youth in assuming responsibility for his or her own care before initiating the transfer. Communication among all providers is essential and should include both personal contact and a written medical summary. Progress toward the transition should be tracked and, once completed, should be documented and assessed. Pediatrics

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Section: Introductionmentioning

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Transitioning HIV-Infected Youth Into Adult Health Care

Chakraborty¹,

Dyke²,

Flynn³

et al. 2013

Pediatrics

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“…95 HIV-infected adolescents may fall out of care when cared for in or transitioning to adult care facilities, which are more focused on the adult environment. 60,96 Early multidisciplinary and developmentally appropriate transition preparation can assist in transitioning youth to adult services. This transition planning ideally would address issues inherent in adolescent health including mental health, medication adherence, sexuality, reproductive health, gender identity, socioeconomic and health insurance status, stigma, disclosure, and disrupted relationships.…”

Section: Discussionmentioning

confidence: 99%

The Adolescent and Young Adult HIV Cascade of Care in the United States: Exaggerated Health Disparities

Zanoni

Mayer²

2014

AIDS Patient Care and STDs

354

315

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Little is known about how adolescents and young adults contribute to the declines in the cascade of care from HIV-1 diagnosis to viral suppression. We reviewed published literature from the Unites States reporting primary data for youth (13-29 years of age) at each stage of the HIV cascade of care. Approximately 41% of HIVinfected youth in the United States are aware of their diagnosis, while only 62% of those diagnosed engage medical care within 12 months of diagnosis. Of the youth who initiate antiretroviral therapy, only 54% achieve viral suppression and a further 57% are not retained in care. We estimate less than 6% of HIV-infected youth in the United States remain virally suppressed. We explore the cascade of care from HIV diagnosis through viral suppression for HIV-infected adolescents and young adults in the United States to highlight areas for improvement in the poor engagement of the infected youth population.

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“…[23][24][25] Younger age also predicted low PrEP adherence in our cohort. 26 Behavioral and psychosocial correlates of nonadherence in young adults include anxiety and depression, 13,27 HIV-1-associated stigma and discrimination, lack of disclosure, feelings of invulnerability to the consequences of HIV-1 disease, 9,28 alcohol and recreational drug use, 27 and low socioeconomic status. 29 These factors may mediate the observed association among younger age, nonadherence, and poor virologic outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…7,8 In resourcerich settings, younger age predicts nonadherence, viral nonsuppression, virologic rebound, and loss to follow-up. 9 Correlates of ART nonadherence include lower income, depression, alcohol and substance use, and lack of social support. [10][11][12][13][14] Nonadherence also occurs when asymptomatic individuals on ART skip doses or stop treatment completely because they feel well.…”

Section: Introductionmentioning

confidence: 99%

Younger Age Predicts Failure to Achieve Viral Suppression and Virologic Rebound Among HIV-1-Infected Persons in Serodiscordant Partnerships

Mujugira

Celum

Tappero

et al. 2016

AIDS Research and Human Retroviruses

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Background: Antiretroviral therapy (ART) markedly reduces the risk of HIV-1 transmission in serodiscordant partnerships. We previously found that younger age and higher CD4 counts were associated with delayed initiation of ART by HIV-1-infected partners in serodiscordant partnerships. Among those initiating ART, we sought to explore whether those same factors were associated with failure to achieve viral suppression. Methods: In a prospective study of HIV-1-infected persons who had a known heterosexual HIV-1-uninfected partner in Kenya and Uganda [Partners Pre-Exposure Prophylaxis (PrEP) Study], we used Cox proportional hazards regression to evaluate correlates of viral nonsuppression (HIV-1 RNA >80 copies/ml). Results: Of 1,035 HIV-1-infected participants initiating ART, 867 (84%) achieved viral suppression: 77% by 6 months and 86% by 12 months. Younger age [adjusted hazard ratio (aHR) 1.05 for every 5 years younger; p = .006], lower pretreatment CD4 count (aHR 1.26; p = .009 for £250 compared with >250 cells/ll), and higher pretreatment HIV-1 RNA quantity (aHR 1.21 per log 10 ; p < .001) independently predicted failure to achieve viral suppression. Following initial viral suppression, 8.8% (76/867) experienced virologic rebound (HIV-1 RNA >200 copies/ml): 6.3% and 11.5% by 6 and 12 months after initial suppression, respectively. Age was the only factor associated with increased risk of virologic rebound (aHR 1.33 for every 5 years younger; p = .005). Conclusions: For HIV-1-infected persons in serodiscordant couples, younger age was associated with delayed ART initiation, failure to achieve viral suppression, and increased risk of virologic rebound. Motivating ART initiation and early adherence is a key to achieving and sustaining viral suppression.

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Clinical Outcomes of Adolescents and Young Adults in Adult HIV Care

Cited by 124 publications

References 29 publications

Transitioning HIV-Infected Youth Into Adult Health Care

Transitioning HIV-Infected Youth Into Adult Health Care

The Adolescent and Young Adult HIV Cascade of Care in the United States: Exaggerated Health Disparities

Younger Age Predicts Failure to Achieve Viral Suppression and Virologic Rebound Among HIV-1-Infected Persons in Serodiscordant Partnerships

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