Clinical outcomes post transition to adult services in young adults with perinatally acquired HIV infection: mortality, retention in care and viral suppression

Foster, Caroline; Ayers, Sara; McDonald, Susan; Frize, Graham; Chhabra, Srishti; Pasvol, Thomas Joshua; Fidler, Sarah

doi:10.1097/qad.0000000000002410

Cited by 26 publications

(25 citation statements)

References 21 publications

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“…Youth who perinatally acquired HIV are likely to be retained in HIV care. In a study in United Kingdom, among young adults with perinatally acquired HIV infection that assessed the clinical outcomes post transition to adult services, 86% of these youths were retained in HIV care [ 27 ]. In a systematic review by Ritchwood et al [ 28 ] to examine retention in HIV care, it indicated that more than 70% of such adolescents who were infected with HIV perinatally were retained in care 1–2 years post-Health Care Transition.…”

Section: Discussionmentioning

confidence: 99%

Retention in HIV care and associated factors among youths aged 15–24 years in rural southwestern Uganda

et al. 2021

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Background Retention in HIV care contributes to antiretroviral therapy adherence, which is a key factor for improved treatment outcomes and prevention of drug resistance. However, HIV treatment among the youths is characterized by loss to follow up, poor adherence to ART, risk of treatment failure and high mortality rates compared to young children and adults. There is limited information about factors associated with retention of youths in HIV care in rural settings in Uganda. We aimed to determine retention in HIV care and associated factors among youths aged 15–24 years in rural southwestern Uganda. Methods A cross-sectional study was conducted among youths aged 15–24 years who were receiving care at the HIV clinic at Kabuyanda HC IV who had been in care for at least 1 year before the study. We used an interviewer-administered questionnaire to collect socio-demographic information. Participant chart abstraction was used to collect information on HIV clinic attendance. We collected information on HIV related stigma using the 40-item Berger Stigma Scale. Chi-square test and multivariable logistic regression analysis were used to determine the factors associated with retention in HIV care with a significance level of < 0.05. Retention in HIV care was, defined as having sought care at least once per quarter in the 12 months prior to the study. Results We enrolled 102 participants with a mean age of 20.95 (SD ± 3.07) years. Two thirds (65.7%) of the youths had been retained in HIV care in the previous 12 months. In adjusted analyses, being male, married and had perinatally acquired HIV were independently associated with retention in HIV care. The association between HIV related stigma and retention in HIV care was not statistically significant. Conclusion Retaining adolescents and young adults in HIV care in rural southwestern Uganda is still much lower than the WHO target of 90%. Being male, having perinatally acquired HIV and married or in a relationship are associated with retention in HIV care. Interventions targeting adolescents and young adults living with HIV are necessary to improve retention in HIV care to the WHO target of 90%.

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Section: Discussionmentioning

confidence: 99%

Retention in HIV care and associated factors among youths aged 15–24 years in rural southwestern Uganda

et al. 2021

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“…APH experience specific challenges due to their life‐long infection and long‐term follow‐up in HIV care [2–6]. They are at risk of inadequate adherence to antiretroviral therapy (ART) [7,8] and poor retention in care during adolescence [9,10]. APH may in turn experience poor health outcomes [11], with a high mortality rate [12,13], virologic failure [14,15] and HIV drug resistance [16], poor growth [17] and immune status [18].…”

Section: Introductionmentioning

confidence: 99%

Growth and CD4 patterns of adolescents living with perinatally acquired HIV worldwide, a CIPHER cohort collaboration analysis

et al. 2022

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Introduction Adolescents living with HIV are subject to multiple co‐morbidities, including growth retardation and immunodeficiency. We describe growth and CD4 evolution during adolescence using data from the Collaborative Initiative for Paediatric HIV Education and Research (CIPHER) global project. Methods Data were collected between 1994 and 2015 from 11 CIPHER networks worldwide. Adolescents with perinatally acquired HIV infection (APH) who initiated antiretroviral therapy (ART) before age 10 years, with at least one height or CD4 count measurement while aged 10–17 years, were included. Growth was measured using height‐for‐age Z‐scores (HAZ, stunting if <‐2 SD, WHO growth charts). Linear mixed‐effects models were used to study the evolution of each outcome between ages 10 and 17. For growth, sex‐specific models with fractional polynomials were used to model non‐linear relationships for age at ART initiation, HAZ at age 10 and time, defined as current age from 10 to 17 years of age. Results A total of 20,939 and 19,557 APH were included for the growth and CD4 analyses, respectively. Half were females, two‐thirds lived in East and Southern Africa, and median age at ART initiation ranged from <3 years in North America and Europe to >7 years in sub‐Saharan African regions. At age 10, stunting ranged from 6% in North America and Europe to 39% in the Asia‐Pacific; 19% overall had CD4 counts <500 cells/mm3. Across adolescence, higher HAZ was observed in females and among those in high‐income countries. APH with stunting at age 10 and those with late ART initiation (after age 5) had the largest HAZ gains during adolescence, but these gains were insufficient to catch‐up with non‐stunted, early ART‐treated adolescents. From age 10 to 16 years, mean CD4 counts declined from 768 to 607 cells/mm3. This decline was observed across all regions, in males and females. Conclusions Growth patterns during adolescence differed substantially by sex and region, while CD4 patterns were similar, with an observed CD4 decline that needs further investigation. Early diagnosis and timely initiation of treatment in early childhood to prevent growth retardation and immunodeficiency are critical to improving APH growth and CD4 outcomes by the time they reach adulthood.

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“…In 2015, mortality associated with HIV was the eighth leading cause of adolescent deaths globally [ 7 ], but in many settings, following children as they move through paediatric care and transition to adult care is challenging for several reasons, including disjointed health systems and lack of capacity to conduct longitudinal research. Of the studies that have measured mortality in adult care [ 8 , 9 , 10 , 11 , 12 ], some are smaller cohorts that may not be representative of the wider population of young people living with PHIV in their respective setting. The UK benefits from a national paediatric cohort, which includes all children diagnosed with HIV and in paediatric care, embedded within the National Health Service, and an ongoing large observational cohort of adults receiving care for HIV [ 13 , 14 ], We conducted data linkage of these two cohorts, which enabled us to assess the incidence of AIDS events and mortality, as well as identify any risk factors, among young people with HIV who transitioned from paediatric to adult care across clinical settings in the UK.…”

Section: Introductionmentioning

confidence: 99%

Mortality and AIDS‐defining events among young people following transition from paediatric to adult HIV care in the UK

et al. 2021

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Objectives To investigate risk of AIDS and mortality after transition from paediatric to adult care in a UK cohort of young people with perinatally acquired HIV. Methods Records of people aged ≥ 13 years on 31 December 2015 in the UK paediatric HIV cohort (Collaborative HIV Paediatric Study) were linked to those of adults in the UK Collaborative HIV Cohort (CHIC) cohort. We calculated time from transition to a new AIDS event/death, with follow‐up censored at the last visit or 31 December 2015, whichever was the earliest. Cumulative incidence of and risk factors for AIDS/mortality were assessed using Kaplan–Meier and Cox regression. Results At the final paediatric visit, the 474 participants [51% female, 80% black, 60% born outside the UK, median (interquartile range) age at antiretroviral therapy (ART) initiation = 9 (5–13) years] had a median age of 18 (17–19) years and CD4 count of 471 (280–663) cell/μL; 89% were prescribed ART and 60% overall had a viral load ≤ 400 copies/mL. Over median follow‐up in adult care of 3 (2–6) years, 35 (8%) experienced a new AIDS event (n = 25) or death (n = 14) (incidence = 1.8/100 person‐years). In multivariable analyses, lower CD4 count at the last paediatric visit [adjusted hazard ratio = 0.8 (95% confidence interval: 0.7–1.0)/100 cells/μL increment] and AIDS diagnosis in paediatric care [2.7 (1.4–5.5)] were associated with a new AIDS event/mortality in adult care. Conclusions Young people with perinatally acquired HIV transitioning to adult care with markers of disease progression in paediatric care experienced poorer outcomes in adult care. Increased investment in multidisciplinary specialized services is required to support this population at high risk of morbidity and mortality.

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Clinical outcomes post transition to adult services in young adults with perinatally acquired HIV infection: mortality, retention in care and viral suppression

Abstract: Objective: Adolescence is the only age group globally where HIV associated mortality is rising, with poorer outcomes at all stages of the care cascade compared to adults. We examined post-transition outcomes for young adults living with perinatal HIV (YAPaHIV).

Cited by 26 publications

References 21 publications

Retention in HIV care and associated factors among youths aged 15–24 years in rural southwestern Uganda

Retention in HIV care and associated factors among youths aged 15–24 years in rural southwestern Uganda

Growth and CD4 patterns of adolescents living with perinatally acquired HIV worldwide, a CIPHER cohort collaboration analysis

Mortality and AIDS‐defining events among young people following transition from paediatric to adult HIV care in the UK

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