Foster, C;
Ayers, S;
Mcdonald, S;
Frize, G;
Chhabra, S;
Pasvol, TJ;
Fidler, S;
(2020)
Clinical outcomes post transition to adult services in young adults with perinatally acquired HIV infection: mortality, retention in care, and viral suppression.
AIDS
, 34
(2)
pp. 261-266.
10.1097/QAD.0000000000002410.
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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). DESIGN: Retrospective cohort analysis. SETTING: A tertiary Youth Friendly Service (YFS) London, UK. PARTICIPANTS: 180 YAPaHIV registered between 01.01.06 and 31.12.17 contributed 921 person-years of follow up post-transition to adult services. INTERVENTION: YFS with multidisciplinary care and walk-in access. MAIN OUTCOME MEASURES: mortality, morbidity, retention in care, antiretroviral (ART) uptake and HIV-viral load (HIV-VL) suppression. Crude incidence rates (CIR) are reported per 1000 person-years. RESULTS: Of 180 youth registered; 4 (2.2%) died, 14 (7.8%) transferred care and 4 (2.2%) were lost to follow up. For the 158 retained in care the median age was 22.9 years (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-VL < 200 copies RNA/ml, median CD4 count of 626 cells/ul (IQR 441-820). The all-cause mortality was 4.3/1000 person-years (95% CI 1.2 - 11.1), ten 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; CIR 18.5/1000 person-years (95% CI 10.8 - 29.6). CONCLUSION: Whilst this youth-friendly multi-disciplinary service achieved high engagement and coverage of suppressive ART, mortality remains markedly increased compared to the general UK population.
| Type: | Article |
|---|---|
| Title: | Clinical outcomes post transition to adult services in young adults with perinatally acquired HIV infection: mortality, retention in care, and viral suppression |
| Location: | England |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1097/QAD.0000000000002410 |
| Publisher version: | https://doi.org/10.1097/QAD.0000000000002410 |
| Language: | English |
| Additional information: | This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10085765 |
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