Pediatric Infectious Diseases Unit, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiGM), Madrid, Spain.
Department of Infectious Diseases and Tropical Pediatrics, Hospital La Paz, Madrid, Spain.
J Acquir Immune Defic Syndr. 2021 Feb 1;86(2):240-247. doi: 10.1097/QAI.0000000000002539.
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.
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.
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.
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.
感染 HIV 的儿童已进入成年期并转入成人诊所。本研究旨在描述围生期 HIV 感染患者在过渡后的临床和免疫病毒学状况。
纳入了 1997 年至 2016 年期间从西班牙多中心儿科 HIV 队列（CoRISpe）转入成人护理（FARO 队列）的患者。从 12 岁起至过渡后最后一次随访时（截至 2017 年 12 月）收集临床和免疫病毒学数据。我们使用混合效应模型分析 CD4 计数或病毒抑制的变化，并使用多变量分析来分析过渡后病毒学失败（VF）和免疫状态的危险因素。过渡年份分为 5 年。
共纳入 332 名青少年。过渡时的中位年龄为 18 岁（四分位距：16.3-18.9），58.1%为女性。过渡后中位随访时间为 6.6 年（四分位距：4.6-9.8），11 例（3.3%）患者死亡。最后几个时期的免疫病毒学状况有所改善。总体而言，VF 从过渡时的 27.7%下降到 3 年后的 14.4%（P<0.001），但在最后两个过渡时期没有观察到变化。在过渡期间，CD4 没有显著变化。过渡后 VF 的危险因素是女性、在国外出生和过渡时的 VF，而过渡后 CD4 较低的危险因素是罗马人后裔、较早过渡、较低的 CD4 最低点和过渡时的 CD4。
过渡后，病毒学抑制在早期过渡期间有所改善，免疫状况保持稳定。然而，一些患者的结局风险较高。确定这些患者可能有助于过渡。
