Universidade de São Paulo, Faculdade de Medicina, Departamento de Molestias Infecciosas e Parasitárias, São Paulo, SP, Brazil.
Universidade de São Paulo, Faculdade de Medicina, Departamento de Molestias Infecciosas e Parasitárias, São Paulo, SP, Brazil.
Braz J Infect Dis. 2019 Sep-Oct;23(5):291-297. doi: 10.1016/j.bjid.2019.07.004. Epub 2019 Aug 31.
HIV-infected children surviving until adulthood have been transitioning to adult outpatient health care service in Brazil since the late 2000's. Deterioration of clinical condition is expected during this period, as reported among youths with non-communicable chronic diseases. Despite their young age, they are long-term hosts of the virus, have prolonged exposure to antiretroviral therapy and have suffered from the social determinants and stigma of HIV infection since early childhood.
This study aimed to 1) describe demographic and clinical characteristics at the first appointment at adult care service following pediatric care of a cohort of Brazilian youths living with HIV since childhood; and 2) retrospectively address adherence and clinical variables in the last two years of pediatric follow-up.
Descriptive study.
41 consecutive patients referred to adult outpatient care from a pediatric HIV unit were enrolled, median age 19 years, and median lifetime CD4+nadir 117 cell/mm; 89% reported previous AIDS-defining conditions. At first laboratory assessment in adult care, only 46% had undetectable (<400 copies/ml) HIV viral load and the median CD4+count was 250 cell/mm.
Youths living with HIV at the transition from pediatric to adult care had poor treatment adherence, low lifetime CD4+cell nadir, low CD4 cell count and detectable HIV viral load. Health care providers should closely monitor these adolescents in a youth friendly environment, prepared for open communication about all aspects of their health.
自 2000 年代末以来，巴西的 HIV 感染儿童在成年后开始过渡到成人门诊医疗服务。在此期间，预计临床状况会恶化，正如非传染性慢性病青年中所报告的那样。尽管他们年龄较小，但他们是病毒的长期宿主，长期接触抗逆转录病毒治疗，并且自童年以来就受到 HIV 感染的社会决定因素和耻辱感的影响。
本研究旨在 1）描述在儿科医疗服务后首次在成人护理服务就诊的巴西青少年 HIV 感染者队列的人口统计学和临床特征；2）回顾性分析儿科随访的最后两年的依从性和临床变量。
描述性研究。
从儿科 HIV 病房转介到成人门诊护理的 41 名连续患者被纳入研究，中位年龄为 19 岁，中位终生 CD4+细胞最低点为 117 个/立方毫米；89%的患者曾报告有 AIDS 定义的疾病。在成人护理的首次实验室评估中，仅有 46%的患者 HIV 病毒载量无法检测到（<400 拷贝/毫升），而中位 CD4+计数为 250 个/立方毫米。
从儿科护理过渡到成人护理的 HIV 感染青少年治疗依从性差，终生 CD4+细胞最低点低，CD4 细胞计数低，HIV 病毒载量可检测。医疗保健提供者应在一个适合青少年的环境中密切监测这些青少年，为他们的所有健康问题做好开放沟通的准备。
