Clinical outcomes post transition to adult services in young adults with perinatally acquired HIV infection: mortality, retention in care and viral suppression
Clinical outcomes post transition to adult services in young adults with perinatally acquired HIV infection: mortality, retention in care and viral suppression
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DOI：
10.1097/qad.0000000000002410
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发表时间：
2020-02-01
期刊：
影响因子：
3.8
通讯作者：
Fidler, Sarah
中科院分区：
文献类型：
--
作者：
Foster, Caroline;Ayers, Sara;Fidler, Sarah
目的：青少年是全球唯一一个艾滋病毒相关死亡率上升的年龄组，与成人相比，在护理级联的所有阶段都有较差的结果。我们研究了患有围产期艾滋病毒的年轻人的过渡后结果。设计：回顾性队列分析。设置：一个大专青年友好服务伦敦，英国.参会人员：2006年1月1日至2017年12月31日期间登记的180名患有围产期艾滋病毒的年轻人在过渡到成人服务后提供了921人年的随访。干预措施：提供多学科护理和无障碍访问的青年友好服务。主要观察指标：死亡率、发病率、护理保留率、抗逆转录病毒治疗（ART）使用率和HIV病毒载量抑制率。报告的粗发病率为每1000人-年。结果：在180名登记的青年中，4人（2.2%）死亡，14人（7.8%）转移护理，4人（2.2%）失访。对于158名继续接受护理的患者，中位年龄为22.9岁[四分位距（IQR）20.3-25.4]，56%为女性，85%为非洲黑人，成人护理的中位随访时间为5.5年（IQR 2.9-7.3）。157例（99.4%）曾接受ART处方，127/157例（81%）最近HIV病毒载量低于200拷贝RNA/ml，中位CD 4（+）细胞计数为626个细胞/μ l（IQR 441-820）。全因死亡率为4.3/1000人-年[95%置信区间（CI）1.2-11.1]，是年龄匹配的英国HIV阴性人群[0.43/1000人-年（95% CI 0.41-0.44）]的10倍。过渡后，17/180（9.4%）发展为新的艾滋病诊断;粗发病率为18.5/1000人-年（95% CI 10.8-29.6）。结论：虽然这种对年轻人友好的多学科服务实现了高参与度和抑制性ART的覆盖率，但与英国普通人群相比，死亡率仍显着增加。
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 with adults. We examined post transition outcomes for young adults living with perinatal HIV. Design: Retrospective cohort analysis. Setting: A tertiary Youth Friendly Service London, UK. Participants: A total of 180 young adults living with perinatal HIV registered between 1 January 2006 and 31 December 2017 contributed 921 person-years of follow-up post transition to adult services. Intervention: Youth Friendly Service with multidisciplinary care and walk-in access. Main outcome measures: Mortality, morbidity, retention in care, antiretroviral therapy (ART) uptake and HIV-viral load suppression. Crude incidence rates are reported per 1000 person-years. Results: Of 180 youth registered, four (2.2%) died, 14 (7.8%) transferred care and four (2.2%) were lost to follow-up. For the 158 retained in care, the median age was 22.9 years [interquartile ranges (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-viral load less than 200 copies RNA/ml, median CD4(+)cell count of 626 cells/mu l (IQR 441-820). The all-cause mortality was 4.3/1000 person-years [95% confidence interval (CI) 1.2-11.1], 10 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; crude incidence rates 18.5/1000 person-years (95% CI 10.8-29.6). Conclusion: While this youth-friendly multidisciplinary service achieved high engagement and coverage of suppressive ART, mortality remains markedly increased compared with the general UK population.