Abstract
Objective: Clinical and psychological HIV-related problems peak during adolescence, which coincides with transition of children and adolescents infected from mothers from pediatric to adult reference centers for HIV infection. Transition often is done without specific programs. We wanted to explore transition as an opportunity to increase the efficacy of care and the psychological well-being through a specific program.Methods: Thirteen vertically infected patients aged 13–20 years were followed up for 24 months by pediatricians, infectious disease specialists, a psychologist, and a nurse. Interventions consisted in joint clinic, simplification of therapy, patient group discussions, HIV infection explanations, and psychological support, lasting 12 months. Efficacy was measured by viro-immunological outcomes and adherence to therapy and psychological tests. Clinical, viro-immunological, and psychological evaluations were performed at 0 (T0) and 12 months (T12) and 6 months after transition to an adult center (T18). Psychological outcomes were assessed using standardized questionnaires for quality of life and self-esteem.Results: In 11/13 participants, pills administrations/day were significantly reduced. Patients with undetectable viral load and CD4+ >25% increased from 61 to 77% and from 61 to 74%, respectively. Six months after transition, all patients exhibited an undetectable viral load. Adolescents' awareness of the severity of the disease and the risk of sexual transmission was generally poor. Patients classified with “severe” psychological distress according to the quality of life index decreased from 38 to 15% and well-being increased. Similar results were observed 6 months after the transition to adult care. No effect was observed on self-esteem index.Conclusions: Specific protocols for transition should be developed to optimize resilience and psychological well-being, including routine psychological support for adolescents with HIV infection transiting from pediatric to adult centers for HIV infection.
Highlights
An increasing number of vertically HIV-infected adolescents are referred to centers for adult [1]
In pediatric HIV infection, as in many other childhood illnesses, the chronicization of the disease has led to new problems including adherence, life-long treatment self-management of the medication side effects, stigma, and— of major importance—awareness of sexual transmission [2, 3]
The number of drugs approved for pediatric patients is limited compared with that for adults, and this may hamper adherence with antiretroviral therapy (ART), because non-adherence is often associated with side effects and psychosocial implications in children and adolescents [4,5,6]
Summary
An increasing number of vertically HIV-infected adolescents are referred to centers for adult [1]. In pediatric HIV infection, as in many other childhood illnesses, the chronicization of the disease has led to new problems including adherence, life-long treatment self-management of the medication side effects, stigma, and— of major importance—awareness of sexual transmission [2, 3]. In a previous study, using the International Classification of Functioning, Disability and Health instrument (ICF), we found that psychosocial issues had a major impact on quality of life than had clinical problems in a population of children and adolescents with HIV infection [10]. The stigma associated with HIV infection is a major barrier to social and psychological health [11]. Sexual transmission of HIV infection inhibits the development of an emotional life in adolescents, affecting the psychosocial stability and the sexual health [12]
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