Mortality and AIDS-defining events among young people following transition from paediatric to adult HIV care in the UK

the Collaborative HIV Paediatric Study (CHIPS) Steering Committee, the UK Collaborative HIV Cohort (UK CHIC) Study Steering Committee

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Abstract

Objectives: To investigate risk of AIDS and mortality after transition from paediatric to adult care in a UK cohort of young people with perinatally acquired HIV. Methods: Records 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. Results: At 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. Conclusions: Young 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.

Original languageEnglish
Pages (from-to)631-640
Number of pages10
JournalHIV Medicine
Volume22
Issue number8
Early online date3 May 2021
DOIs
Publication statusE-pub ahead of print - 3 May 2021

Bibliographical note

Funding Information:
CS has received financial support from Gilead Sciences and ViiV Healthcare for membership of data safety and monitoring boards, advisory boards and for preparation of educational materials. FP has received honoraria from Gilead, MSD and ViiV, and grant funding (to his institution) from Gilead, ViiV, MSD and Janssen. All other authors declare there are no conflicts of interest. Conflict of interest:

Funding Information:
This research was funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in partnership with PHE and in collaboration with the London School of Hygiene and Tropical Medicine. The views expressed are those of the authors and not necessarily those of the NIHR, the Department of Health and Social Care or Public Health England. Financial disclosure:

Funding Information:
CHIPS is funded by the National Health Service England (London Specialised Commissioning Group) and has received additional support from Abbott Laboratories ( https://Abbott.co.uk/ ), Boehringer Ingelheim, Bristol‐Myers Squibb, GlaxoSmithKline, Gilead Sciences, Janssen and Roche. The MRC Clinical Trials Unit at UCL is supported by the UKRI Medical Research Council ( https://www.mrc.ac.uk ) programme number MC_UU_12023/26.

Funding Information:
The UK CHIC Study is funded by the Medical Research Council, UK (grant nos G0000199, G0600337, G0900274 and M004236).

Publisher Copyright:
© 2021 The Authors. HIV Medicine published by John Wiley & Sons Ltd on behalf of British HIV Association.

Keywords

  • AIDS
  • HIV
  • mortality
  • transition
  • young people
  • THERAPY
  • INFECTION
  • CHILDREN

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