Mortality and AIDS-defining events among young people following transition from paediatric to adult HIV care in the UK.
Mortality and AIDS-defining events among young people following transition from paediatric to adult HIV care in the UK.
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DOI：
10.1111/hiv.13096
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发表时间：
2021-09
期刊：
影响因子：
3
通讯作者：
Collaborative HIV Paediatric Study (CHIPS) Steering Committee, the UK Collaborative HIV Cohort (UK CHIC) Study Steering Committee
中科院分区：
文献类型：
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作者：
Asad H;Collins IJ;Goodall RL;Crichton S;Hill T;Doerholt K;Foster C;Lyall H;Post FA;Welch S;Winston A;Sabin CA;Judd A;Collaborative HIV Paediatric Study (CHIPS) Steering Committee, the UK Collaborative HIV Cohort (UK CHIC) Study Steering Committee
在英国一组围产期获得性HIV感染的年轻人中，研究从儿科护理过渡到成人护理后的艾滋病风险和死亡率。2015年12月31日，英国儿科HIV队列（协作HIV儿科研究）中年龄≥ 13岁的患者记录与英国协作HIV队列（CHIC）中的成人记录相关。我们计算了从过渡到新发艾滋病事件/死亡的时间，在末次访视或2015年12月31日（以最早者为准）进行随访删失。使用Kaplan-Meier和考克斯回归分析评估AIDS/死亡的累积发病率和危险因素。在最后一次儿科访视时，474名参与者[51%为女性，80%为黑人，60%出生在英国以外，中位数开始抗逆转录病毒治疗（ART）时的年龄= 9（5-13）岁]的中位年龄为18（17-19）岁，CD 4计数为471（280-663）个细胞/μL; 89%的患者接受ART治疗，60%的患者病毒载量≤ 400拷贝/mL。在成人护理中位随访3（2-6）年期间，35例（8%）患者发生新发AIDS事件（n = 25）或死亡（n = 14）（发生率= 1.8/100人年）。在多变量分析中，末次儿科访视时较低的CD 4计数[校正风险比= 0.8（95%置信区间：0.7-1.0）/100个细胞/μL增量]和儿科护理中的AIDS诊断[2.7（1.4-5.5）]与成人护理中新发AIDS事件/死亡率相关。患有围产期获得性艾滋病毒的年轻人在儿科护理中有疾病进展标志物，过渡到成人护理，在成人护理中的结果较差。需要增加对多学科专门服务的投资，以支助这一发病率和死亡率高风险人群。
To investigate risk of AIDS and mortality after transition from paediatric to adult care in a UK cohort of young people with perinatally acquired HIV. Records of people aged ≥ 13 years on 31 December 2015 in the UK paediatric HIV cohort (Collaborative HIV Paediatric Study) were linked to those of adults in the UK Collaborative HIV Cohort (CHIC) cohort. We calculated time from transition to a new AIDS event/death, with follow‐up censored at the last visit or 31 December 2015, whichever was the earliest. Cumulative incidence of and risk factors for AIDS/mortality were assessed using Kaplan–Meier and Cox regression. At the final paediatric visit, the 474 participants [51% female, 80% black, 60% born outside the UK, median (interquartile range) age at antiretroviral therapy (ART) initiation = 9 (5–13) years] had a median age of 18 (17–19) years and CD4 count of 471 (280–663) cell/μL; 89% were prescribed ART and 60% overall had a viral load ≤ 400 copies/mL. Over median follow‐up in adult care of 3 (2–6) years, 35 (8%) experienced a new AIDS event (n = 25) or death (n = 14) (incidence = 1.8/100 person‐years). In multivariable analyses, lower CD4 count at the last paediatric visit [adjusted hazard ratio = 0.8 (95% confidence interval: 0.7–1.0)/100 cells/μL increment] and AIDS diagnosis in paediatric care [2.7 (1.4–5.5)] were associated with a new AIDS event/mortality in adult care. Young people with perinatally acquired HIV transitioning to adult care with markers of disease progression in paediatric care experienced poorer outcomes in adult care. Increased investment in multidisciplinary specialized services is required to support this population at high risk of morbidity and mortality.
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