6th IAS Conference On HIV Pathogenesis, Treatment and Prevention

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Transition of HIV- infected adolescents to Adult HIV care: 2 years of follow-up

S.E. Arazi Caillaud1, D. Mecikovsky1, A. Bordato2, J. Lattner3, D. Ameri3, R. Posada4, P. Cahn3, R. Bologna1

1Garrahan, Pediatrics Infectious Diseases Unit, Buenos Aires, Argentina, 2Garrahan, Pediatrics Mental Health Unit, Buenos Aires, Argentina, 3Fernandez, Infectious Diseases Division, Buenos Aires, Argentina, 4Mount Sinai School of Medicine, Pediatrics Infectious Diseases Unit, New York, United States

Background: With the advent of HAART, the expected life span of HIV infected children has increased and so transitioning adolescents into adult care represents a new challenge. Methods: We perform a prospective study to evaluate a transition program. Adolescents ≥16 years who acquired HIV as children were enrolled at one tertiary pediatric hospital and transitioned to one adult HIV care program. 110 patients were enrolled between June 2007 and December 2010. We analyzed epidemiological, clinical, immunological and virological characteristics of 20 patients transitioned to Fernandez Hospital.
Results: 20 patients were transitioned, 16 (80%) with success (defined as at keeping least 2 appointments and having at least 1 laboratory test done in the 6 months following the transition at the adult hospital) with a median follow up of 20 months (IQR 9-26). 11 (55%) were females with a median age of 20 years (IQR 18.5-21) No patient worsened its CDC stage during the follow-up period (at transition time 45% were on CDC clinical stage C, 60% on immunological stage 3. At the adult clinic, a median of 3 visits and 2 CD4/viral load were done: 12 (75%) were virologically suppressed and 13 (86.7%) had CD4 ≥350 cells/mL. 4 (25%) patients had a new clinical event (Bacterial pneumonia: 3, diarrhea: 1) 2 were admitted to ICU. 18 (80%) are on HAART with a median of 4 previous ARV regimens (IQR:2-6), 2 (12.5%) patients needed a treatment change due to virological failure and 33% required at least 2 new drugs.
Conclusions: HIV-infected adolescents present an advanced stage of disease at transition to adult care. Albeit having been exposed to several drugs, viral load suppression is an attainable goal. Transition from a pediatric to an adult hospital represents a new challenge that can be successfully overcome with joint interdisciplinary programs. (Fogarty AITRP #5D43 TW001037).


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