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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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Weijsenfeld AM, Smit C, Cohen S, Wit FW, Mutschelknauss M, van der Knaap LC, van Zonneveld LM, Zomer BJ, Nauta N, Patist JC, Kuipers-Jansen MH, Smit EP, Blokhuis C, Pajkrt D, ,


Weijsenfeld AM, Smit C, Cohen S, Wit FW, Mutschelknauss M, van der Knaap LC, van Zonneveld LM, Zomer BJ, Nauta N, Patist JC, Kuipers-Jansen MH, Smit EP, Blokhuis C, Pajkrt D, , (click to view)

Weijsenfeld AM, Smit C, Cohen S, Wit FW, Mutschelknauss M, van der Knaap LC, van Zonneveld LM, Zomer BJ, Nauta N, Patist JC, Kuipers-Jansen MH, Smit EP, Blokhuis C, Pajkrt D, ,

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Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 2016 Jul 2063(8) 1105-12 doi 10.1093/cid/ciw487

Abstract
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.

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