MRC Clinical Trials Unit at UCL, London, UK.
St Mary's Hospital, Imperial College NHS Healthcare Trust, London, UK.
J Int AIDS Soc. 2019 Sep;22(9):e25379. doi: 10.1002/jia2.25379.
The UNAIDS 90-90-90 targets for the cascade of care are widely used to monitor the success of HIV care programmes but there are few studies in children. We assessed the cascade for children and adolescents living with HIV in the national Collaborative HIV Paediatric Study (CHIPS) in the UK and Ireland.
Utilizing longitudinal data from CHIPS we compared the cascade of care for 2010, 2013 and 2016. Among children diagnosed with HIV and not known to be lost to follow-up at the start of each calendar year, we summarized the proportion in active paediatric care during that year (defined as having ≥1 clinic visit, CD4 or viral load measurement, or change to antiretroviral therapy (ART) regimen), and of these, the proportion on ART at last visit in that year. Among those on ART, the proportion with viral suppression (<200 copies/mL) and good immune status (WHO immunological stage none-/mild-for-age) at last visit in the year were summarized. Among those in care in 2016, outcomes were compared by current age, place of birth (born abroad vs. UK/Ireland) and sex.
Of children in paediatric HIV care at the start of 2010, 2013 and 2016 (n = 1249, 1157, 905 respectively), the proportion in active care during that calendar year was high throughout at 97 to 99%. Of those in active care, the proportion on ART increased from 79% to 85% and 92% respectively (p < 0.001). Among those on ART, the proportion with viral suppression and good immune status was stable at 83% to 86% and 85% to 88%, respectively, across the years. Among children in care in 2016, those aged ≥15 years were less likely to be virally suppressed (79% vs. 91%, p < 0.001) or to have good immune status (78% vs. 94%, p < 0.001) compared to younger children; there were no differences by place of birth or sex.
Children and adolescents in the UK and Ireland national cohort had high retention in care. The proportion on ART increased significantly over time although there was no change in viral suppression or good immune status. Poorer outcomes among adolescents highlight the need for targeted support for this population.
UNAIDS 的 90-90-90 护理级联目标被广泛用于监测艾滋病毒护理计划的成功，但针对儿童的研究较少。我们评估了英国和爱尔兰国家合作艾滋病毒儿科研究（CHIPS）中感染艾滋病毒的儿童和青少年的护理级联。
利用 CHIPS 的纵向数据，我们比较了 2010 年、2013 年和 2016 年的护理级联。在每年开始时未失访的诊断出患有艾滋病毒的儿童中，我们总结了当年处于活跃儿科护理中的比例（定义为至少有 1 次就诊、CD4 或病毒载量测量或改变抗逆转录病毒治疗（ART）方案），在这些儿童中，当年最后一次就诊时正在接受 ART 的比例。在接受 ART 的儿童中，总结了当年最后一次就诊时病毒抑制（<200 拷贝/ml）和良好免疫状态（世卫组织免疫分期无/轻度年龄相关）的比例。在 2016 年接受护理的儿童中，根据当前年龄、出生地（在国外出生与在英国/爱尔兰出生）和性别比较了结局。
在 2010 年、2013 年和 2016 年开始接受儿科艾滋病毒护理的儿童中（分别为 1249 名、1157 名和 905 名），当年活跃护理的比例在整个期间都很高，为 97%至 99%。在活跃护理的儿童中，接受 ART 的比例分别从 79%增加到 85%和 92%（p<0.001）。在接受 ART 的儿童中，病毒抑制和良好免疫状态的比例分别稳定在 83%至 86%和 85%至 88%。在 2016 年接受护理的儿童中，年龄≥15 岁的儿童病毒抑制（79%比 91%，p<0.001）或免疫状态良好（78%比 94%，p<0.001）的可能性较低与年龄较小的儿童相比；出生地或性别没有差异。
英国和爱尔兰国家队列中的儿童和青少年在护理中保持高保留率。尽管病毒抑制或良好免疫状态没有变化，但接受 ART 的比例随着时间的推移显著增加。青少年的结果较差突出表明需要针对这一人群提供有针对性的支持。
