Abstract
ObjectivesTo investigate risk of AIDS and mortality after transition from paediatric to adult care in a UK cohort of young people with perinatally acquired HIV.MethodsRecords 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.ResultsAt 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.ConclusionsYoung 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.
Highlights
The UK benefits from a national paediatric cohort, which includes all children diagnosed with HIV and in paediatric care, embedded within the National Health Service, and an ongoing large observational cohort of adults receiving care for HIV [13,14], We conducted data linkage of these two cohorts, which enabled us to assess the incidence of AIDS events and mortality, as well as identify any risk factors, among young people with HIV who transitioned from paediatric to adult care across clinical settings in the UK
In the UK, all children born to women with HIV, and those diagnosed with HIV aged < 16 years are reported to the National Surveillance of HIV in Pregnancy and Childhood (NSHPC). They are subsequently followed through paediatric care in the Collaborative HIV Paediatric Study (CHIPS), follow-up ceases when they transfer to adult care [13,15], The UK Collaborative HIV Cohort (CHIC) Study is an ongoing study collecting clinical data of adults aged ≥ 16 years accessing HIV care from some of the largest HIV clinics in the UK [14], and includes any young people followed in CHIPS who have transferred to one of the 25 participating adult clinics
Deaths are reported to the UK Collaborative HIV Cohort (UK CHIC) Study by participating clinics and additional mortality reports are obtained through annual linkage to national surveillance reports coordinated by Public Health England (PHE)
Summary
Of the studies that have measured mortality in adult care [8,9,10,11,12], some are smaller cohorts that may not be representative of the wider population of young people living with PHIV in their respective setting. The UK benefits from a national paediatric cohort, which includes all children diagnosed with HIV and in paediatric care, embedded within the National Health Service, and an ongoing large observational cohort of adults receiving care for HIV [13,14], We conducted data linkage of these two cohorts, which enabled us to assess the incidence of AIDS events and mortality, as well as identify any risk factors, among young people with HIV who transitioned from paediatric to adult care across clinical settings in the UK
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