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

Abstract

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.

Children living with HIV in Europe: do migrants have worse treatment outcomes?

“…This difference was greater when analysis was restricted to migrants born in sub‐Saharan Africa. Further monitoring is required, in particular as children and adolescents move into young adulthood and transition to adult HIV care [ 17 ]. In addition, tuberculosis represented a higher proportion of the reported AIDS events among migrants, highlighting the need for screening and treatment of latent tuberculosis infection in this population.…”

Adults with Perinatally Acquired HIV; Emerging Clinical Outcomes and Data Gaps

“…In an Italian cohort, people LWPaHIV aged 18 to 30+ years, rates of dual, triple and four-class resistance, were 41%, 20% and 6%, respectively, with 7% having at least one mutation conferring integrase resistance by 2019 [ 26 ]. Comparable rates of triple class resistance were observed in Spanish adults LWPaHIV (15%), although lower rates were observed in a comparable UK cohort (6%) [ 8 , 27 ]. Triple class resistance was reported in pregnant women LWPaHIV, with the potential for a transmitted drug resistance in infected infants making treatment extremely challenging [ 28 ].…”

Pregnancy Outcomes Among Perinatally HIV-Infected Women in Spain

“…To define a patient with VF, we considered 2 consecutive VLs >50 copies/mL, 6 months apart. For these women, pol sequences for resistance testing derived from previous studies 2 , 19 – 21 and major resistance mutations to protease inhibitor, nucleoside/nucleotide reverse transcriptase inhibitor, and non-nucleoside reverse transcriptase inhibitor identified by the “Stanford University HIV Drug Resistance Database” 22 were also collected.…”

“…Previous exposure to several antiretroviral therapy (ART) regimens, the subsequent selection of drug-resistant viruses, treatment adherence difficulties, and psychosocial problems are common in this population. 1 , 2 The challenge for clinicians managing young WLWPHIV is increased during pregnancy, as all these factors can affect perinatal transmission and lead to adverse pregnancy outcomes. 3 Although the numbers are small, the risk of mother-to-child HIV transmission seems to be higher among WLWPHIV, according to most studies.…”