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A total of 1.8 million adolescents live with HIV and constitute the only age group in which HIV-associated mortality continues to rise. Meeting their healthcare needs as they transition from paediatric services to adult care is vital for their own health and in prevention of onward transmission to partners and offspring. In this review, we discuss the issues around transition, both within HIV health care and the wider transitions adolescents negotiate as they move out of childhood and into adult life.Although transition models vary widely across the globe, the difficulties faced in gathering robust outcome data following transition to adult care and in linkage between paediatric and adult cohorts are universal. Data are particularly sparse for behaviourally infected adolescents outside North America and for key population groups. Poorer health outcomes universal to adolescents may reflect the complex multisystem developmental transition from childhood-to-adulthood, of which transition of healthcare services is a small part.The complex needs of this generation are well described and whilst examples of good practice are emerging, how best to support their transition to adulthood requires carefully tailored studies of cost-effective interventions that can be up scaled in resource limited settings.