Journal Article

Clinical Status of Adolescents with Perinatal HIV at Transfer to Adult Care in the UK/Ireland

Collins, Intira Jeannie, Riordan, Andrew, Foster, Caroline, Gibb, DM, Tookey, Pat, Dunn, David, Tostevin, Anna, Judd, Ali

2017

Overview

Background. Increasing numbers of children infected perinatally with human immunodeficiency virus (HIV) are surviving to adolescence and transitioning to adult care, yet there are scarce data on their clinical status at transfer. Methods. We analyzed prospective cohort data from the UK/Ireland national Collaborative HIV Pediatric Study (CHIPS). Clinical status at last pediatric clinic visit prior to transfer was described. Factors associated with higher CD4 cell count and viral load (VL) suppression<400 c/mL among patients on antiretroviral therapy (ART) at transfer were assessed using linear and logistic regression, respectively. Data were matched with the UK HIV Drug Resistance Database (UKHIVDRB) to assess cumulative resistance profiles at transfer. Results. Of 1,907 children followed in CHIPS from 1996 to November 2014, 644 (34%) transferred to adult care: 53% were female, 62% born outside the UK/Ireland, 75% black African. At last pediatric follow-up, median age was 17.4 years [interquartile range 16.5,18.1], 27% had previous AIDS diagnosis, CD4 was 444 cells/mm3 [280, 643], 76% were on ART, 13% off-ART, and 11% ART-naive. Among patients on ART, 74% had VL<400 c/mL. In multivariable analysis, higher CD4 at transfer was associated with younger age, higher CD4 at ART initiation and lower VL at transfer (P ≤ .001). Predictors of viral suppression include no AIDS diagnosis and later year of transfer (P ≤ .05). Of 291 patients with resistance data, 82% had resistance to ≥1 drug class, 56% to ≥2 classes and 12% had triple-class resistance. Conclusion. Three-quarters of adolescents were on stable ART at transfer, of whom 74% were virologically suppressed. The prevalence of triple-class resistance was relatively low at 12%.

• Publisher: Oxford University Press
• Subject: Adolescent / Adolescents / Anti-HIV Agents - therapeutic use / Antiretroviral agents / Antiretroviral drugs / ARTICLES AND COMMENTARIES / CD4 Lymphocyte Count / Child / Child, Preschool / Disease transmission / Drug resistance / Drug Resistance, Viral / Female / HIV / HIV - drug effects / HIV - isolation & purification / HIV Infections - drug therapy / HIV Infections - epidemiology / HIV Infections - pathology / HIV Infections - virology / Human immunodeficiency virus / Humans / Infant / Infant, Newborn / Ireland - epidemiology / Lentivirus / Male / Prospective Studies / Regression analysis / Retroviridae / Teenagers / Transition to Adult Care / United Kingdom - epidemiology / Viral Load