Young People in the United Kingdom and Ireland with Perinatally Acquired HIV: The Pediatric Legacy For Adult Services

Foster, Caroline; Judd, Ali; Tookey, P; Tudor‐Williams, Gareth; Dunn, David; Shingadia, Delane; Butler, Karina; Sharland, Mike; Gibb, D.M.; Lyall, Hermione

doi:10.1089/apc.2008.0153

Cited by 80 publications

(88 citation statements)

References 30 publications

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“…1 In the UK, the average age of individuals with PaHIV is 15 years, and one quarter of the perinatal cohort are in adult care. 2 Globally, 25% of children have failed first line therapy, 1 in 8 children have triple class failure within 4 years of starting ART, with poor adherence the commonest factor.…”

Section: Introductionmentioning

confidence: 99%

“Payment by Results”—Financial Incentives and Motivational Interviewing, Adherence Interventions in Young Adults with Perinatally Acquired HIV-1 Infection: A Pilot Program

Foster

McDonald

Frize

et al. 2014

AIDS Patient Care and STDs

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Emerging evidence suggests financial incentives (FIs) improve medication adherence in select populations. A small proportion of adolescents with perinatal HIV (PaHIV) transfer to adult services with established poor adherence and advanced disease. We describe a single center adherence intervention combining FIs with motivational interviewing (MI). Eligible patients (PaHIV,16-25 years, CD4 count ≤ 200, off ART despite multiple attempts) received MI, and FI dependent on viral load (VL) reduction for 1 year. Outcome measures compared CD4 gain from baseline at 1 year and 12 months post cessation of FI/MI. Eleven young people enrolled; median age 19 years, 8 female. Baseline median CD4 count 30 cells/μL (IQR 10-160), VL 12,870 c/mL. Outcomes at 12 months: 9/11 ever achieved VL < 50, 5 sustained undetectable VL, median CD4 140, mean CD4 gain 90 cells/μL at 1 year. Twelve months post cessation of MI/FI; six VL < 50, median CD4 75, mean CD4 gain 122 cells/μL. Total FI expenditure £1,350: £68 per 50 CD4 cells at 1 year, £55 at 24 months. To prevent death, adolescents with PaHIV require novel interventions to reverse poor patterns of adherence established since childhood. FI/MI improved virological and immunological outcomes with minimal expenditure. Extension of this pilot work for vulnerable individuals is now indicated.

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Section: Introductionmentioning

confidence: 99%

“Payment by Results”—Financial Incentives and Motivational Interviewing, Adherence Interventions in Young Adults with Perinatally Acquired HIV-1 Infection: A Pilot Program

Foster

McDonald

Frize

et al. 2014

AIDS Patient Care and STDs

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“…The success of highly active antiretroviral therapy (HAART) has meant that more children with vertically acquired HIV infection are surviving into adolescence and young adulthood; the size of this cohort in the UK is expected to continue to increase [1]. In addition, young people aged 16 to 24 years account for around 11% of new HIV diagnoses in the United Kingdom each year [2].…”

Section: Introductionmentioning

confidence: 99%

Pregnancy in HIV-infected teenagers in London

et al. 2010

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There were 67 pregnancies in 58 young women, of whom one was known to have acquired HIV vertically. The overall mother-to-child transmission (MTCT) rate of HIV was 1.5% (one of 66). There were 66 live births. Median ages at HIV diagnosis and conception were 17 and 18 years, respectively. Sixty-three per cent of women were diagnosed with HIV infection through routine antenatal screening. Eighty-two per cent of pregnancies (41 of 50) were unplanned, with 65% of women (26 of 40) using no contraception. Forty-three per cent of the women (20 of 46) had a past history of a sexually transmitted infection (STI). In 63 pregnancies, antiretroviral therapy was started postconception, with prevention of HIV MTCT the only indication in 81% of cases. Fifty-eight per cent of those on highly active antiretroviral therapy (HAART) had an undetectable HIV viral load by delivery. Eighty-seven per cent were uncomplicated pregnancies. Seventy-one per cent delivered by Caesarean section and 21% (14 of 64) had a preterm delivery (o37 weeks). In the 12 months after delivery, 45% of women received contraceptive advice and 25% of women became pregnant again. ConclusionObstetric and virological outcomes were favourable in this group of HIV-infected young women. However, the majority of pregnancies were unplanned with poor documentation of contraception use and advice and low rates of STI screening. A quarter of women conceived again within 12 months of delivery. Effective measures to reduce STIs, unplanned pregnancies and onward HIV transmission in HIV-infected teenagers are needed. Studies exploring pregnancy in HIV-infected adolescents are limited. The largest described 1183 live births in 1090 pregnant adolescents in the United States, the majority of whom had acquired HIV infection sexually [11]. Most pregnancies were unplanned (83%) and occurred in teenagers who had previously been pregnant (67%).A prospective cohort study of 638 vertically infected girls, again in the USA, reported 45 pregnancies, with 17% of girls experiencing a first pregnancy by their 19th birthday [8]. Of the 32 pregnancies resulting in live births, one infant was HIV-infected, 29 were uninfected and two had unknown infection status. Chibber and Khurranna also reported favourable obstetric outcomes and no cases of vertical transmission in a study of 30 pregnant vertically infected adolescents in India [12]. Other case series have described similar findings [13][14][15]. In a small European study, there were nine live births with no mother-to-child transmissions [16]. To date there have been no studies in the UK looking at pregnancy in teenagers living with HIV.In this study we reviewed the pregnancies of 58 HIVinfected teenagers attending for care at 12 London hospitals. We explore the medical and social features of this group and describe their sexual and reproductive health issues, their response to antiretroviral therapy (ART) and pregnancy outcome. MethodsWe conducted a retrospective case note review of HIVinfected pregnant female patients aged between 13 and...

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“…When the hindrances to adequate adherence to treatment during childhood are not removed, PHIV adolescents might not achieve appropriate viral suppression and often exhibit multidrug resistance-associated mutations [55] . Several studies have shown that the proportion of PHIV adolescents with viral suppression is approximately 50% [56][57][58][59] .…”

Section: Viral Drug Resistancementioning

confidence: 99%

Perinatally infected adolescents living with human immunodeficiency virus (perinatally human immunodeficiency virus)

Cruz

Cardoso

2015

WJV

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Young People in the United Kingdom and Ireland with Perinatally Acquired HIV: The Pediatric Legacy For Adult Services

Cited by 80 publications

References 30 publications

“Payment by Results”—Financial Incentives and Motivational Interviewing, Adherence Interventions in Young Adults with Perinatally Acquired HIV-1 Infection: A Pilot Program

“Payment by Results”—Financial Incentives and Motivational Interviewing, Adherence Interventions in Young Adults with Perinatally Acquired HIV-1 Infection: A Pilot Program

Pregnancy in HIV-infected teenagers in London

Perinatally infected adolescents living with human immunodeficiency virus (perinatally human immunodeficiency virus)

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