Clinical Status of Adolescents with Perinatal HIV at Transfer to Adult Care in the UK/Ireland
Clinical Status of Adolescents with Perinatal HIV at Transfer to Adult Care in the UK/Ireland
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DOI：
10.1093/cid/cix063
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发表时间：
2017-04-15
影响因子：
11.8
通讯作者：
Judd, Ali
中科院分区：
文献类型：
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作者：
Collins, Intira Jeannie;Foster, Caroline;Judd, Ali
背景越来越多的围产期感染人类免疫缺陷病毒（HIV）的儿童存活到青春期并过渡到成人护理，但很少有关于他们转移时临床状态的数据。我们分析了来自英国/爱尔兰国家合作HIV儿科研究（CHIPS）的前瞻性队列数据。描述了转移前末次儿科门诊访视时的临床状态。分别采用线性和逻辑回归分析，对接受抗逆转录病毒治疗（ART）的患者在转移时CD 4细胞计数较高和病毒载量（VL）抑制< 400 c/mL的相关因素进行评估。将数据与英国HIV耐药数据库（UKHIVDRB）进行匹配，以评估转移时的累积耐药情况。从1996年到2014年11月，在CHIPS跟踪的1，907名儿童中，有644名（34%）转移到成人护理：53%是女性，62%出生在英国/爱尔兰以外，75%是非洲黑人。在最后一次儿科随访中，中位年龄为17.4岁[四分位距16.5，18.1]，27%的患者曾被诊断为艾滋病，CD 4为444个细胞/mm（3）[280，643]，76%的患者接受抗逆转录病毒治疗，13%的患者未接受抗逆转录病毒治疗，11%的患者未接受抗逆转录病毒治疗。在接受ART的患者中，74%的VL< 400 c/mL。在多变量分析中，转移时较高的CD 4与较年轻、ART开始时较高的CD 4和转移时较低的VL相关（P = 2级，12%具有三级耐药）。四分之三的青少年在转移时接受稳定的抗逆转录病毒治疗，其中74%的人病毒学受到抑制。三级耐药的发生率相对较低，为12%。
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/mm(3) [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 = 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%.