SHM data in research: virological failure in adolescents and young adults
Could you briefly describe your main findings?
The aim of the study was to analyse the virological outcomes of HIV-infected adolescents and young adults (12-24 years of age) who had been using combination antiretroviral therapy (cART) for a longer period of time, and thus to identify potential predictive factors for virological failure. Patients were eligible for inclusion if they had been receiving treatment in a Dutch paediatric HIV treatment centre and had then transitioned to adult HIV care. In total, 59 HIV-infected adolescents and young adults were included in the study, with a median age at HIV diagnosis of 8 years ( interquartile range [IQR] 3-13), a median age at the start of cART of 10 years (IQR 7-14), and a median follow-up time of 10 years (IQR 8-12). Transition to adult care occurred at a median age of 18.8 years (IQR 18-20).
Virological failure was defined as two consecutive HIV viral load measurements greater than 400 copies/ml in patients who had been taking cART for at least 6 months. The analysis showed that virological failure is associated with being 18-20 years of age (odds ratio [OR] 4.26; 95% confidence interval [95% CI] 1.12-16.28, P=0.03), a low level of education (OR 3.32; 95% CI 1.39-7.92, P=0.007) and insufficient autonomy in terms of medication adherence at the time of transition (OR 6.98; 95% CI 2.57- 18.5, P= <0.001).
During the study period, 8 patients disappeared from care completely. On average, this occurred 18 months after transition to adult care (range 0-5 years), and we also found that the child protection services had been more frequently involved during paediatric care in this group than in the group that did remain in care after transition ( 75% versus 29%, respectively; P= 0.02)
What is new about your study?
As far as we are aware, we are the first to have monitored the outcomes of HIV-infected adolescents and young adults over a long period of time, making use of data from both the paediatric and adult HIV treatment centres.
In our study, we show that adolescents and young adults have a high risk of virological failure, particularly during the period of transition to adult care. It is often thought that the transition itself, in other words the move to adult care, has a negative effect on outcomes. However, we have shown that it’s not necessarily the switch itself, but rather the age at which it takes place that plays an important role in determining outcomes. This is evidenced by the fact that the rise in the number of patients failing actually starts before time of transition.
What are your plans for future research?
This study focussed primarily on adolescents and young adults infected with HIV at birth. However, worldwide, young adults (18-24 years) who have acquired HIV through a different transmission route are also a vulnerable group because they are not yet fully mature adults. Nonetheless, this group is often studied together with ‘older’ adults. It would therefore be interesting to also examine the outcomes of this group over a longer period of time, allowing us in the future to make more targeted changes to care that would improve the outcomes for this vulnerable group.
The full article is available online
Weijsenfeld AM, Smit C, Cohen S, Wit FWNM, Mutschelknauss M, van der Knaap LC, van Zonneveld LM, Zomer BJ, Nauta N, Patist JC, Kuipers-Jansen MHJ, Smit EP, Blokhuis C, and Pajkrt D, for the Dutch HIV Adolescents and Young Adults (AYA) Study Group. HIV/AIDS: Virological and social outcomes of HIV-infected adolescents and young adults in the Netherlands before and after transition to adult care. Clin Infect Dis. first published online July 20, 2016 doi:10.1093/cid/ciw487