Transition from paediatric to adult care among persons with perinatal HIV infection in New York City, 2006–2015

Xia, Qiang; Abraham, Bisrat; Shah, Dhara; Ramaswamy, Chitra; Braunstein, Sarah L.; Torian, Lucia V.

doi:10.1097/qad.0000000000001923

Cited by 16 publications

(19 citation statements)

References 29 publications

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“…Of these, 69 articles focused on HCT for ALWH. Further refinement based on inclusion of preand post-HCT data for quantitative studies and transition outcomes for qualitative studies resulted in a sample of 16 quantitative [30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] and 8 qualitative studies [12,[46][47][48][49][50][51][52].…”

Section: Search Resultsmentioning

confidence: 99%

“…One of the US studies reported 41 deaths within the first year of transition for the 735 patients who transitioned. 82.9% were from HIV-related diseases [45].…”

Section: Mortality Among Adolescents Post-hctmentioning

confidence: 98%

“…African American participants were at a greater likelihood to have unsuppressed viremia than other ethnic groups [p = .04]. Another study US-based study found that, of the 735 ALWH who had successfully transitioned to adult care, in addition to trends indicating poorer retention in HIV care over a three-year period, proportions of ALWH with suppressed viremia were suboptimal, ranging from approximately 49-52% [45], which are similar to estimates reported in other studies [40,45]. Data from a Canadian cohort of 54 youth indicated that pre-HCT, most ALWH (64%) had a CD4+ count > 500 cells/mm 3 , 20% had a CD4+ count of <200cells/mm 3 , and 16% had a CD4+ count between 200 and 500 cells/mm 3 [30].…”

Section: Change In Cd4+ Count and Vl Post-hctmentioning

confidence: 99%

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Healthcare retention and clinical outcomes among adolescents living with HIV after transition from pediatric to adult care: a systematic review

et al. 2020

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Background: Adolescents living with HIV (ALWH) who transition from pediatric to adult care face several challenges that increase their risk of experiencing treatment interruptions and being lost to HIV care with resultant increased morbidity and mortality. To date, few studies have examined their outcomes post-healthcare transition (HCT), precluding the development and dissemination of evidence-based interventions aimed at retaining ALWH in HIV care both during and after HCT. We conducted a systematic review to synthesize the outcomes of ALWH post-HCT to provide suggestions for future directions. Methods: We systematically searched several electronic databases through October 2019 using keywords for HIV, HCT and ALWH. We categorized studies by target population, country (i.e., upper-high income and low-middle income), study design (i.e., descriptive, mixed methods, quantitative), outcomes measured, and follow-up period. Results: A total of 24 studies met inclusion criteria. Studies were categorized according to the following HCT outcomes: retention in HIV care post-HCT (n = 13), changes in CD4+ count and viral load post-HCT (n = 16), and mortality among ALWH post-HCT (n = 7). Most studies (n = 11) examining retention in HIV care indicated that more than 70% of ALWH were retained in care 1-2 years post-HCT while the remaining studies (n = 2) reported retention rates less than 55%. While studies indicated that CD4+ counts and viral loads tended to worsen during the first few years post-HCT, these differences were often not statistically significant. Among all ALWH who transitioned to adult care, a small proportion died within their first seven years post-HCT. Among qualitative studies, common themes included transition readiness (n = 6), provider-patient relationship in the adult clinic setting (n = 6), and concern about the adult clinic setting (n = 4). Conclusions: Transition outcomes were poorest for ALWH with unsuppressed viremia pre-HCT, suggesting that this subgroup of ALWH may need greater support from their treatment teams and caregivers during and post-HCT to improve clinical outcomes.

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Section: Search Resultsmentioning

confidence: 99%

“…One of the US studies reported 41 deaths within the first year of transition for the 735 patients who transitioned. 82.9% were from HIV-related diseases [45].…”

Section: Mortality Among Adolescents Post-hctmentioning

confidence: 98%

Section: Change In Cd4+ Count and Vl Post-hctmentioning

confidence: 99%

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Healthcare retention and clinical outcomes among adolescents living with HIV after transition from pediatric to adult care: a systematic review

et al. 2020

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“…In other settings, transition to adult care for perinatally HIV-infected youth has had adverse effects on retention in care, viral suppression, and mortality. An evaluation of transition to adult care for perinatally HIV-infected youth in New York found higher rates of retention in care and viral suppression after transition, but saw mortality increase nearly 25-fold in the first year after transition [ 16 ]. In a cohort from Maryland, 60% of perinatally HIV-infected youth were retained in care one year after transition and only 38% were virally suppressed [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Transition from pediatric to adult care for adolescents living with HIV in South Africa: A natural experiment and survival analysis

et al. 2020

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Objective To determine rates of retention and viral suppression among adolescents living with perinatally-acquired HIV who remained in pediatric care compared to those who transitioned to adult care. Methods We evaluated a natural experiment involving adolescents living with perinatally-acquired HIV who were attending a government-supported antiretroviral clinic in KwaZulu-Natal, South Africa. Prior to 2011, all adolescents transitioned to adult care at 12 years of age. Due to a policy change, all adolescents were retained in pediatric care after 2011. We analyzed adolescents two years before and two years after this policy change. Outcomes were retention in care and HIV viral suppression one year after transition to adult care or the 13 th birthday if remaining in pediatric care. Results In the natural experiment, 180 adolescents who turned 12 years old between 2011 and 2014 were evaluated; 35 (20%) transitioned to adult care under the old policy and 145 (80%) remained in pediatric care under the new policy. Adolescents who transitioned to the adult clinic had lower rates of retention in care (49%; 17/35) compared to adolescents remaining in the pediatric clinic (92%; 134/145; p<0.001). Retention in care was lower (ARR 0.59; 95%CI 0.43–0.82; p = 0.001) and viral suppression was similar (ARR = 1.06, 95%CI 0.89–1.26; p = 0.53) for adolescents who transitioned to adult care compared to adolescents remaining in pediatric care. Conclusion Adolescents living with perinatally-acquired HIV appear to have higher retention in care when cared for in pediatric clinics compared to adult clinics. Longer-term follow-up is needed to fully assess viral suppression.

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“…However, little is known about their current health status in each country, despite an expected increase in the number of children being transferred into adult units in the coming years. Several studies have assessed the current state of adolescent survivors of perinatally or early acquired HIV 9,[11][12][13][14][15][16][17] . Table 3 shows all related studies on HIV-1 patients transferred from paediatric to adult units worldwide.…”

Section: Discussionmentioning

confidence: 99%

Virological outcome among HIV infected patients transferred from pediatric care to adult units in Madrid, Spain (1997–2017)

Beltrán-Pavez

Gutiérrez

Rubio-Garrido

et al. 2020

Sci Rep

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The aim of this transversal study was to describe the virological and immunological features of HIV-infected youths transferred from pediatric to adult care units since 1997 vs. the non-transferred patients from the Madrid Cohort of HIV-infected children and adolescents in Spain. We included 106 non-transferred and 184 transferred patients under clinical follow-up in 17 public hospitals in Madrid by the end of December 2017. Virological and immunological outcomes were compared in transferred vs. non-transferred patients. ART drug resistance mutations and HIV-variants were analyzed in all subjects with available resistance pol genotypes and/or genotypic resistance profiles. Among the study cohort, 133 (72.3%) of 184 transferred and 75 (70.7%) of 106 non-transferred patients had available resistance genotypes. Most (88.9%) of transferred had ART experience at sampling. A third (33.3%) had had a triple-class experience. Acquired drug resistance (ADR) prevalence was significantly higher in pretreated transferred than non-transferred patients (71.8% vs. 44%; p = 0.0009), mainly to NRTI (72.8% vs. 31.1%; p < 0.0001) and PI (29.1% vs. 12%; p = 0.0262). HIV-1 non-B variants were less frequent in transferred vs. non-transferred (6.9% vs. 32%; p < 0.0001). In conclusion, the frequent resistant genotypes found in transferred youths justifies the reinforcement of HIV resistance monitoring after the transition to avoid future therapeutic failures.

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Transition from paediatric to adult care among persons with perinatal HIV infection in New York City, 2006–2015

Abstract: Persons with perinatal HIV infection in NYC who transitioned from paediatric to adult care saw improvements in CD4 cell count and viral suppression after transition. The increase in mortality after transition was likely caused by the conditions before or leading to the transition.

Cited by 16 publications

References 29 publications

Healthcare retention and clinical outcomes among adolescents living with HIV after transition from pediatric to adult care: a systematic review

Healthcare retention and clinical outcomes among adolescents living with HIV after transition from pediatric to adult care: a systematic review

Transition from pediatric to adult care for adolescents living with HIV in South Africa: A natural experiment and survival analysis

Virological outcome among HIV infected patients transferred from pediatric care to adult units in Madrid, Spain (1997–2017)

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