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Mortality in perinatally HIV ‐infected young people in E ngland following transition to adult care: an HIV Y oung P ersons N etwork ( HYPNet ) audit
Author(s) -
Fish R,
Judd A,
Jungmann E,
O'Leary C,
Foster C
Publication year - 2014
Publication title -
hiv medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.53
H-Index - 79
eISSN - 1468-1293
pISSN - 1464-2662
DOI - 10.1111/hiv.12091
Subject(s) - medicine , psychosocial , adult care , young adult , pediatrics , human immunodeficiency virus (hiv) , viral load , cause of death , disease , family medicine , psychiatry
Objectives Mortality in young people with perinatally acquired HIV infection ( PHIV ) following transfer to adult care has not been characterized in the UK . We conducted a multicentre audit to establish the number of deaths and associated factors. Methods Fourteen adult clinics caring for infected young people reported deaths to 30 S eptember 2011 on a proforma. Deaths were matched to the Collaborative HIV Paediatric Study, a clinical database of HIV ‐infected children in the UK / I reland, to describe clinical characteristics in paediatric care of those who died post‐transition. Results Eleven deaths were reported from 14 clinics which cared for 248 adults with PHIV . For the 11 deaths, the median age at transfer to adult care was 17 years (range 15–21 years), and at death was 21 years (range 17–24 years). Causes of death were suicide (two patients), advanced HIV disease (seven patients) and bronchiectasis (one patient), with one cause missing. At death, the median CD 4 count was 27 cells/μL (range 0–630 cells/μL); five patients were on antiretroviral therapy ( ART ) but only two had a viral load < 50 HIV ‐1 RNA copies/mL. Nine had poor adherence when in paediatric care, continuing into adult care despite multidisciplinary support. Eight had ART resistance, although all had potentially suppressive regimens available. Nine had mental health diagnoses. Conclusions Our findings highlight the complex medical and psychosocial issues faced by some adults with PHIV , with nine of the 11 deaths in our study being associated with poor adherence and advanced HIV disease. Novel adherence interventions and mental health support are required for this vulnerable cohort.