Clinical, Immunological, and Virological Outcomes Among Youths With Perinatal HIV After Transition to Adult Units in Spain From 1997 to 2016
Por:
Aguilera-Alonso, D, Sainz, T, de Ory, S, Bernardino, I, Diez, C, Torres, B, Merino, D, Iribarren, J, Portilla, I, Rios, M, Ibarra, S, Sanz, J, Bellon, J, Carrasco, I, Munoz-Fernandez, M, Ramos, J, Navarro, M, CoRISpe Cohort Working Grp and CoRISpe-FARO Cohort Working Grp
Publicada:
1 feb 2021
Resumen:
Background: Children living with HIV are reaching adulthood and transitioning to adult clinics. This study aimed to describe clinical and immunovirological status after transition in patients with perinatal HIV. Methods: Patients participating in the Spanish multicenter pediatric HIV cohort (CoRISpe) transferred to adult care (FARO cohort) from 1997 to 2016 were included. Clinical and immunovirological data were collected from 12 years old to the last follow-up moment after transition (up to December 2017). We used mixed-effect models to analyze changes in CD4 counts or viral suppression and multivariate analysis for risk factors for virological failure (VF) and immune status after transition. Transition years were classified into 5-year periods. Results: Three hundred thirty-two youths were included. The median age at transition was 18 years (interquartile range: 16.3-18.9) and 58.1% women. The median follow-up time after transition was 6.6 years (interquartile range: 4.6-9.8), and 11 patients (3.3%) died. The immunovirological status at transition improved over the last periods. Globally, VF decreased from 27.7% at transition to 14.4% at 3 years post-transition (P < 0.001), but no changes were observed in the last 2 transition periods. There were no significant differences in CD4 over the transition period. Risk factors for VF after transition were female sex, being born abroad and VF at transition, and for lower CD4 after transition were Romani heritage, younger age at transition, lower CD4 nadir, and CD4 at transition. Conclusions: After transition, virological suppression improved in the early transition periods, and immunological status remained stable. Nevertheless, some patients had higher risk of worse outcomes. Identifying these patients may aid during transition.
Filiaciones:
Aguilera-Alonso, D:
Hosp Gen Univ Gregorio Maranon, Inst Invest Sanitaria Gregorio Maranon IiGM, Pediat Infect Dis Unit, Madrid, Spain
Sainz, T:
Hosp La Paz, Dept Infect Dis & Trop Pediat, Madrid, Spain
de Ory, S:
Hosp Gen Univ Gregorio Maranon, Pediat Infect Dis Unit, Madrid, Spain
Bernardino, I:
Hosp La Paz Carlos III Cantoblanco, Infect Dis Unit, Madrid, Spain
Diez, C:
Hosp Gen Univ Gregorio Maranon, Infect Dis HIV Unit, Madrid, Spain
Fdn Invest Biomed, Inst Invest Sanitaria Gregorio Maranon IiSGM, Madrid, Spain
Torres, B:
Hosp Clin Barcelona, Infect Dis Dept, HIV Unit, Barcelona, Spain
Inst Invest Biomed August Pi & Sunyer IDIBAPS, Barcelona, Spain
Merino, D:
Hosp Univ Juan Ramon Jimenez Huelva, Infect Dis Unit, Huelva, Spain
Iribarren, J:
Hosp Univ Donostia, Inst BioDonostia, Infect Dis Unit, Donostia San Sebastian, Spain
:
Hosp Gen Univ Alicante, Infect Dis Dept, Alicante, Spain
Univ Alicante, Dept Hlth Psychol, Alicante, Spain
Rios, M:
Hosp Univ Virgen Macarena, Unit Infect Dis, Seville, Spain
Ibarra, S:
Hosp Basurto, Infect Dis Unit, Bilbao, Spain
Sanz, J:
Hosp Univ Principe Asturias, Infect Dis Unit, Alcala De Henares, Spain
Bellon, J:
Inst Invest Sanitaria Gregorio Maranon, Madrid, Spain
Carrasco, I:
Inst Invest Sanitaria Gregorio Maranon, Madrid, Spain
Munoz-Fernandez, M:
Hosp Gen Univ Gregorio Maranon, Sect Immunol, Madrid, Spain
Spanish HIV HGM BioBank, Madrid, Spain
Ramos, J:
Hosp Clin San Carlos, Dept Pediat, Madrid, Spain
Navarro, M:
Univ Complutense Madrid, Red Invest Translac Infectol Pediat RITIP, Inst Invest Sanitaria Gregorio Maranon IiGM, Hosp Gen Univ Gregorio Maranon,Pediat Infect Dis, Madrid, Spain
Bronze
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