Clinical outcomes post transition to adult services in young adults with perinatally acquired HIV infection: mortality, retention in care and viral suppression. (1st February 2020)

• Record Type: Journal Article
• Authors: Foster, Caroline; Ayers, Sara; Mcdonald, Susan; Frize, Graham; Chhabra, Srishti; Pasvol, Thomas Joshua; Fidler, Sarah
• Is Part Of: AIDS. Volume 34:Number 2(2020)
• Publication Date: 2020-02-01
• Subjects: mortality -- perinatally acquired HIV -- retention in care -- transition -- viral suppression; AIDS (Disease) -- Periodicals; Acquired Immunodeficiency Syndrome; AIDS (Disease); Periodicals; Periodicals; 616.9792005
• DOI: 10.1097/QAD.0000000000002410
• Languages: English
• ISSNs: 0269-9370

Abstract

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 with adults. We examined post transition outcomes for young adults living with perinatal HIV. Design: Retrospective cohort analysis. Setting: A tertiary Youth Friendly Service London, UK. Participants: A total of 180 young adults living with perinatal HIV registered between 1 January 2006 and 31 December 2017 contributed 921 person-years of follow-up post transition to adult services. Intervention: Youth Friendly Service with multidisciplinary care and walk-in access. Main outcome measures: Mortality, morbidity, retention in care, antiretroviral therapy (ART) uptake and HIV-viral load suppression. Crude incidence rates are reported per 1000 person-years. Results: Of 180 youth registered, four (2.2%) died, 14 (7.8%) transferred care and four (2.2%) were lost to follow-up. For the 158 retained in care, the median age was 22.9 years [interquartile ranges (IQR) 20.3–25.4], 56% were female, 85% Black African, with a median length of follow-up in adult care of 5.5 years (IQR 2.9–7.3). 157 (99.4%) ever received an ART prescription, 127/157 (81%) with a latest HIV-viral load less than 200 copies RNA/ml, median CD4 + cell count of 626 cells/μl (IQR 441–820). The all-cause mortality was 4.3/1000 person-years [95% confidence interval (CI) 1.2–11.1], 10 fold the aged-matched UK HIV-negative population [0.43/1000 person-years (95% CI 0.41–0.44)]. Post transition, 17/180 (9.4%) developed a new AIDS diagnosis; crude incidence rates 18.5/1000 person-years (95% CI 10.8–29.6). Conclusion: While this youth-friendly multidisciplinary service achieved high engagement and coverage of suppressive ART, mortality remains markedly increased compared with the general UK population.