Virological and Social Outcomes of HIV-Infected Adolescents and Young Adults in The Netherlands Before and After Transition to Adult Care
Virological and Social Outcomes of HIV-Infected Adolescents and Young Adults in The Netherlands Before and After Transition to Adult Care
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DOI：
10.1093/cid/ciw487
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发表时间：
2016-10-15
影响因子：
11.8
通讯作者：
Pajkrt, Dasja
中科院分区：
文献类型：
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作者：
Weijsenfeld, Annouschka M.;Smit, Colette;Pajkrt, Dasja
背景由于有效的联合抗逆转录病毒治疗（cART）和先进的支持性医疗保健，越来越多的人类免疫缺陷病毒（HIV）感染的儿童存活到成年。向成人护理的过渡期通常与治疗依从性受损和护理中断有关。我们的目的是评估艾滋病毒感染的青少年和年轻人（AYAs）的病毒学和社会的结果之前和之后的过渡，并探讨哪些因素与病毒学失败。我们纳入了来自荷兰的59名HIV感染的AYA，他们已经进入儿科护理并从儿科过渡到成人护理。我们使用了来自荷兰Stichting HIV监测数据库（1996-2014）的HIV RNA载量和cART数据，并从所有荷兰儿科HIV治疗中心和14个荷兰成人治疗中心的患者病历中收集了社会和治疗数据。我们在一个逻辑回归模型中评估了病毒学失败（VF）的危险因素，并对重复测量进行了调整。HIV VF在研究期间频繁发生（14%-36%）。在过渡期（18 - 19岁），与12-13岁儿童的参考组相比，VF显著增加（比值比，4.26 [95%置信区间，1.12-16.28]; P=.03）。与VF显著相关的特征是受教育程度低和过渡期对药物依从性缺乏自主性。感染艾滋病毒的AYA容易发生VF，特别是在过渡期。识别HIV感染的青少年VF的高风险可能有助于提高治疗成功率。
Background. As a result of effective combination antiretroviral therapy (cART) and advanced supportive healthcare, a growing number of human immunodeficiency virus (HIV)-infected children survive into adulthood. The period of transition to adult care is often associated with impaired adherence to treatment and discontinuity of care. We aimed to evaluate virological and social outcomes of HIV-infected adolescents and young adults (AYAs) before and after transition, and explore which factors are associated with virological failure.Methods. We included 59 HIV-infected AYAs from the Netherlands who had entered into pediatric care and transitioned from pediatric to adult healthcare. We used HIV RNA load and cART data from the Dutch Stichting HIV Monitoring database (1996-2014), and collected social and treatment data from patients' medical records from all Dutch pediatric HIV treatment centers and 14 Dutch adult treatment centers involved. We evaluated risk factors for virological failure (VF) in a logistic regression model adjusted for repeated measurements.Results. HIV VF occurred frequently during the study period (14%-36%). During the transition period (from 18 to 19 years of age) there was a significant increase in VF compared with the reference group of children aged 12-13 years (odds ratio, 4.26 [95% confidence interval, 1.12-16.28]; P=.03). Characteristics significantly associated with VF were low educational attainment and lack of autonomy regarding medication adherence at transition.Conclusions. HIV-infected AYAs are vulnerable to VF, especially during the transition period. Identification of HIV-infected adolescents at high risk for VF might help to improve treatment success in this group.