Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Infectious Disease Department, Hospital Nacional Arzobispo Loayza, Lima, Peru.
J Adolesc Health. 2024 Feb;74(2):260-267. doi: 10.1016/j.jadohealth.2023.08.041. Epub 2023 Oct 7.
Published data on outcomes among adolescents newly initiating antiretroviral treatment in the Latin American context are sparse. We estimated the frequency of sustained retention with viral load suppression (i.e., successful transition) and identified predictors of successful transition into adult care among youth (aged 14-21 years) with recently acquired HIV in Lima, Peru.
A retrospective cohort study was conducted among 184 adolescents and young adults who initiated antiretroviral therapy in an adult public sector HIV clinic between June 2014 and June 2019. Sustained retention (no loss-to-follow-up or death) with viral suppression was calculated for the first 12 and 24 months following treatment initiation. We conducted regression analyses to assess factors associated with successful transition to adult HIV care, including gender, age, occupation, nationality, pregnancy, same-sex sexual behavior, presence of treatment supporter, number of living parents, and social risk factors that may adversely influence health (e.g., lack of social support, economic deprivation).
Patients were predominantly male (n = 167, 90.8%). Median age was 19 years (interquartile range: 18-21). Frequency of sustained retention with viral load suppression was 42.4% (78/184) and 35.3% (30/85) at 12 and 24 months following treatment initiation. In multivariable analyses, working and/or studying was inversely associated with successful transition into adult care at 12 months; number of known living parents (relative risk: 2.20; 95% confidence interval: 1.12, 4.34) and absence of social risk factors (relative risk: 1.68; 95% confidence interval: 0.91, 3.11) were positively associated with successful transition at 24 months.
Sustained retention in HIV care was uncommon. Parental support and interventions targeting social risk factors may contribute to successful transition into adult HIV care in this group.
在拉丁美洲背景下，新启动抗逆转录病毒治疗的青少年的结局相关数据较为匮乏。我们评估了病毒载量抑制下持续保留（即成功过渡）的频率，并确定了秘鲁利马新感染艾滋病毒的青少年（14-21 岁）成功过渡到成人护理的预测因素。
我们对 2014 年 6 月至 2019 年 6 月期间在一家成人公立部门艾滋病毒诊所开始抗逆转录病毒治疗的 184 名青少年和年轻人进行了回顾性队列研究。计算了治疗开始后 12 个月和 24 个月内病毒抑制下持续保留（无失访或死亡）的比例。我们进行了回归分析，以评估与成功过渡到成人艾滋病毒护理相关的因素，包括性别、年龄、职业、国籍、妊娠、同性性行为、是否有治疗支持者、父母健在的人数以及可能对健康产生不利影响的社会风险因素（例如缺乏社会支持、经济贫困）。
患者主要为男性（n=167，90.8%）。中位年龄为 19 岁（四分位距：18-21 岁）。治疗开始后 12 个月和 24 个月时，病毒载量抑制下持续保留的比例分别为 42.4%（78/184）和 35.3%（30/85）。在多变量分析中，工作和/或学习与 12 个月时成功过渡到成人护理呈负相关；已知健在的父母人数（相对风险：2.20；95%置信区间：1.12，4.34）和无社会风险因素（相对风险：1.68；95%置信区间：0.91，3.11）与 24 个月时的成功过渡呈正相关。
艾滋病毒护理的持续保留并不常见。父母的支持和针对社会风险因素的干预措施可能有助于该人群成功过渡到成人艾滋病毒护理。
