HIV-infected youths transitioning from pediatric to adult outpatient care in a teaching tertiary care hospital in São Paulo city, Brazil

Abstract

Background: HIV-infected children surviving until adulthood have been transitioning to adult outpatient health care service in Brazil since the late 2000's. Deterioration of clinical condition is expected during this period, as reported among youths with non-communicable chronic diseases. Despite their young age, they are long-term hosts of the virus, have prolonged exposure to antiretroviral therapy and have suffered from the social determinants and stigma of HIV infection since early childhood.

Objectives: This study aimed to 1) describe demographic and clinical characteristics at the first appointment at adult care service following pediatric care of a cohort of Brazilian youths living with HIV since childhood; and 2) retrospectively address adherence and clinical variables in the last two years of pediatric follow-up.

Methods: Descriptive study.

Results: 41 consecutive patients referred to adult outpatient care from a pediatric HIV unit were enrolled, median age 19 years, and median lifetime CD4+nadir 117 cell/mm³; 89% reported previous AIDS-defining conditions. At first laboratory assessment in adult care, only 46% had undetectable (<400 copies/ml) HIV viral load and the median CD4+count was 250 cell/mm³.

Conclusion: Youths living with HIV at the transition from pediatric to adult care had poor treatment adherence, low lifetime CD4+cell nadir, low CD4 cell count and detectable HIV viral load. Health care providers should closely monitor these adolescents in a youth friendly environment, prepared for open communication about all aspects of their health.

Keywords: Adolescent; Adult care; Pediatric HIV; Transition-to-care; Young adult.

Figure 1

Box plots of (a) HIV viral load (log₁₀ copies/ml) and (b) CD4 + cell count (cells/mm³) measured at the first visit to the adult outpatient care service, according to adherence status during pediatric care service.