Transition from paediatric to adult care among persons with perinatal HIV infection in New York City, 2006–2015

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Abstract

Objective:

The aim of this study was to evaluate the transition process from paediatric to adult care among persons with perinatal HIV infection in New York City (NYC).

Design:

A retrospective prepost study and a matched exposed/unexposed nested cohort study.

Methods:

Using data from the NYC HIV registry, a retrospective prepost study was performed among persons who transitioned from paediatric to adult care to assess pre and posttransition retention in care (≥1 CD4+ cell count/viral load in a 12-month period), CD4+ cell count and viral suppression (≤200 copies/ml). A 1 : 3 matched exposed/unexposed nested cohort study was conducted to assess pre and posttransition 1-year mortality by matching persons who transitioned to adult care and persons who remained in paediatric care on calendar year (±1 year) and age at transition (±1 year).

Results:

A total of 735 persons with perinatal HIV infection transitioned to adult care in NYC during 2006–2015, of whom 53.9% were women, 57.7% black and 37.1% Hispanic. Pretransition (Year 0), and posttransition Year 1, Year 2 and Year 3 proportions of persons with CD4+ cell count at least 500 cells/μl were 35.2, 38.3, 38.9 and 39.0%, respectively, and viral suppression were 45.9, 48.6, 51.1 and 51.8%, respectively. One-year mortality rates before and after transition were 2.3/1000 and 55.8/1000, respectively.

Conclusion:

Persons with perinatal HIV infection in NYC who transitioned from paediatric to adult care saw improvements in CD4+ cell count and viral suppression after transition. The increase in mortality after transition was likely caused by the conditions before or leading to the transition.

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