Easing the Transition of HIV-Infected Adolescents to Adult Care
Easing the Transition of HIV-Infected Adolescents to Adult Care
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DOI：
10.1089/apc.2013.0253
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发表时间：
2013-12-01
影响因子：
4.9
通讯作者：
Cervia, Joseph S.
中科院分区：
文献类型：
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作者：
Cervia, Joseph S.
在婴儿和儿童采用联合抗逆转录病毒疗法(CART)后，过去二十年见证了艾滋病毒相关发病率和死亡率的大幅下降。治疗结果的改善改变了艾滋病毒流行的面貌，也改变了患者和家属的需求。因此，许多在围产期和行为上感染的青少年现在正在过渡到成人护理。以下是对原始研究、综述和临床指南的简要回顾和评论，这些研究、综述和临床指南描述了在促进艾滋病毒感染青年向成人护理过渡方面的挑战和最佳做法。在接下来的十年里，超过25,000名13-24岁的感染艾滋病毒的美国青年将需要过渡到成人护理。过渡规划必须解决认知发展和精神健康、服药依从性、性行为、生殖和性别认同、社会经济和健康保险状况、污名和披露、中断与儿科护理提供者的关系以及沟通等问题。艾滋病毒和其他慢性疾病的临床经验支持多学科、对发展敏感的方法，以应对护理过渡中的固有挑战，这一过渡很早就开始，并通过定期评估和修订进行监测。美国卫生与公众服务部和纽约州卫生部艾滋病研究所提出了具体的临床建议。
The past two decades have witnessed dramatic reductions in HIV-related morbidity and mortality following the introduction of combination antiretroviral therapy (cART) for infants and children. Improved therapeutic outcomes have changed the face of the HIV epidemic and with it the needs of patients and families. Consequently, many perinatally- and behaviorally-infected adolescents are now transitioning to adult care. What follows is a brief review and commentary concerning original research, reviews, and clinical guidelines describing challenges and best practices in facilitating care transitions for HIV-infected youth to adult care. Over 25,000 HIV-infected US youth aged 13-24 years will require transition to adult care within the next decade. Transition planning must address issues of cognitive development and mental health, medication adherence, sexuality, reproductive, and gender identity, socioeconomic and health insurance status, stigma and disclosure, disrupted relationships with pediatric care providers, and communication. Clinical experience with HIV and other chronic illnesses supports a multidisciplinary, developmentally-sensitive approach to meeting the challenges inherent in care transition that begins early and is monitored with regular evaluation and revision. Specific clinical recommendations have been made by the U.S. Department of Health and Human Services and the New York State Department of Health AIDS Institute.