Spotlight on SHM data in research: virological outcomes in young adults with behaviourally-acquired HIV on cART
Annouschka Weijsenfeld is an HIV nursing consultant and researcher at AmsterdamUMC, AMC site, where she works in both the paediatric and adult HIV treatment teams. These combined roles give her a unique insight into the issues facing young people living with HIV and in care in the Netherlands. Following an earlier paper on virological failure in perinatally-infected adolescents and young adults during the period of transition from paediatric to adult care, she has now investigated the longitudinal risk of virological failure in young adults living with behaviourally-acquired HIV. We spoke to Annouschka to find out more about her latest research.
Could you summarise the main findings of your research?
In this study we looked at how effective HIV treatment is in young people between 18 and 24 years old with behaviourally-acquired HIV and in care in a Dutch HIV treatment centre. We know that this is a vulnerable group and previous research has shown that they generally do less well on treatment than older adults with HIV. We therefore wanted to look at this group separately. We found that the results improved over the course of time, from 2000 to 2015, and that viral suppression in young people with HIV and on treatment is now comparable with that of adults living with HIV, i.e., around 95%. This is a very positive outcome.
Why did you undertake this study?
Many studies treat children who are born with HIV and those who acquire it later as a single group. But this makes it very difficult to properly interpret the outcomes. In our previous study we looked specifically at those who had acquired HIV perinatally and how they fared in the period during the transition from paediatric care to adult care. In that study we looked at the children according to age category and we saw that there were problems with treatment compliance prior to the transition period, although we were unable to look at outcomes in the longer term. We also think that, for various reasons, there is a difference between young people with perinatally-acquired HIV and those with behaviourally-acquired HIV. We therefore decided to look at the latter over time.
What is new about your study?
This study shows that these young adults in the Netherlands are now also doing well on treatment. We believe this is primarily because medication has improved, with fewer side effects and less treatment burden due to the availability of single-pill regimens. Most studies, mainly carried out in the UK or the US, often consider young adults as a problem group. We therefore felt it was important to look at the effect of time in this group. Together with researchers at SHM, such as Ferdinand Wit, we decided to look at the changes in virological failure from 2000 onwards. We chose this year partly based on the data available in SHM’s database and partly because we could be sure that there was adequate treatment available then and that our outcomes would therefore not be clouded by sub-optimal treatment.
We also saw that within the group of young people with behaviourally-acquired HIV, the men who have sex with men (MSM) had better viral suppression rates than those who acquired HIV through heterosexual contact. We are not sure why this is, but the hiv-vereniging [the Dutch HIV patients’ association] has published a report showing that heterosexuals were more like to have HIV-related depressive symptoms than MSM and were also less likely to seek support from family and friends in coping with their HIV. Moreover, the MSM group of young adults may know more about HIV and may therefore be more aware of the importance of treatment compliance.
What are your plans for future research?
I would like to return to my first study to take another look at the group of young people who acquired HIV perinatally. More individuals should have made the switch to adult HIV care and we also have a longer follow-up period for the initial group. It is important to look at these young people over a longer period of time and also to assess comorbidities. In addition, I am very interested to know what the effect of time is in this group. And of course, then we have to start thinking about what we are going to do with the information in daily practice.