Pradthana Ounchanum, Linda Aurpibul, Sirinya Teeraananchai, Pagakrong Lumbiganon, Wipaporn Natalie Songtaweesin, Tavitiya Sudjaritruk, Kulkanya Chokephaibulkit, Supattra Rungmaitree, Pope Kosalaraksa, Tulathip Suwanlerk, Jeremy L Ross, Annette H Sohn, Thanyawee Puthanakit
{"title":"泰国围产期感染艾滋病毒的青少年和年轻成人在向成年过渡期间的高死亡率。","authors":"Pradthana Ounchanum, Linda Aurpibul, Sirinya Teeraananchai, Pagakrong Lumbiganon, Wipaporn Natalie Songtaweesin, Tavitiya Sudjaritruk, Kulkanya Chokephaibulkit, Supattra Rungmaitree, Pope Kosalaraksa, Tulathip Suwanlerk, Jeremy L Ross, Annette H Sohn, Thanyawee Puthanakit","doi":"10.1080/09540121.2024.2325100","DOIUrl":null,"url":null,"abstract":"<p><p>Transitioning from pediatric to adult care remains a challenge for adolescents and young adults with perinatally-acquired HIV (AYA-PHIV). We assessed treatment outcomes and mortality among Thai AYA-PHIV. The study included AYA-PHIV who reached age 18-24 years who started antiretroviral treatment during childhood at five pediatric HIV clinics across Thailand. From November 2020-July 2021, data were gathered from a cohort database, medical records, and the Thai National AIDS Program. Of 811 eligible AYA-PHIV, 93% were alive; median age 22.3 years (IQR 20.6-23.7), treatment duration 16.1 years (IQR 13.4-18.0). Current HIV care was provided in adults (71%) and pediatric clinics (29%). Treatment regimens included non-nucleoside reverse transcriptase inhibitors (55%), protease inhibitors (36%), and integrase inhibitors (8%); 78% had HIV RNA <200 copies/ml. Of the 7.0% who died, median age at death was 20.8 years (IQR 20.6-22.1); 88% were AIDS-related death. Mortality after age 18 was 1.76 per 100-person years (95% confidence interval 1.36-2.28). Those with CD4 <200 cell/mm<sup>3</sup> at age 15 had higher risk of mortality (adjusted hazard ratio 6.16, 95% CI 2.37-16.02). In conclusion, the high mortality among Thai AYA-PHIV indicated the need for better systems to support AYA-PHIV during the transition to adulthood.</p>","PeriodicalId":48370,"journal":{"name":"Aids Care-Psychological and Socio-Medical Aspects of Aids/hiv","volume":" ","pages":"964-973"},"PeriodicalIF":1.2000,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11518584/pdf/","citationCount":"0","resultStr":"{\"title\":\"High mortality in adolescents and young adults with perinatally-acquired HIV in Thailand during the transition to adulthood.\",\"authors\":\"Pradthana Ounchanum, Linda Aurpibul, Sirinya Teeraananchai, Pagakrong Lumbiganon, Wipaporn Natalie Songtaweesin, Tavitiya Sudjaritruk, Kulkanya Chokephaibulkit, Supattra Rungmaitree, Pope Kosalaraksa, Tulathip Suwanlerk, Jeremy L Ross, Annette H Sohn, Thanyawee Puthanakit\",\"doi\":\"10.1080/09540121.2024.2325100\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>Transitioning from pediatric to adult care remains a challenge for adolescents and young adults with perinatally-acquired HIV (AYA-PHIV). We assessed treatment outcomes and mortality among Thai AYA-PHIV. The study included AYA-PHIV who reached age 18-24 years who started antiretroviral treatment during childhood at five pediatric HIV clinics across Thailand. From November 2020-July 2021, data were gathered from a cohort database, medical records, and the Thai National AIDS Program. Of 811 eligible AYA-PHIV, 93% were alive; median age 22.3 years (IQR 20.6-23.7), treatment duration 16.1 years (IQR 13.4-18.0). Current HIV care was provided in adults (71%) and pediatric clinics (29%). Treatment regimens included non-nucleoside reverse transcriptase inhibitors (55%), protease inhibitors (36%), and integrase inhibitors (8%); 78% had HIV RNA <200 copies/ml. Of the 7.0% who died, median age at death was 20.8 years (IQR 20.6-22.1); 88% were AIDS-related death. Mortality after age 18 was 1.76 per 100-person years (95% confidence interval 1.36-2.28). Those with CD4 <200 cell/mm<sup>3</sup> at age 15 had higher risk of mortality (adjusted hazard ratio 6.16, 95% CI 2.37-16.02). 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引用次数: 0
摘要
对于感染了围产期艾滋病病毒(AYA-PHIV)的青少年和年轻成人来说,从儿科治疗过渡到成人治疗仍然是一项挑战。我们对泰国青少年艾滋病病毒感染者的治疗效果和死亡率进行了评估。研究对象包括年满 18-24 岁、在儿童时期开始接受抗逆转录病毒治疗的青少年艾滋病病毒感染者,他们在泰国各地的五家儿科艾滋病诊所接受治疗。2020 年 11 月至 2021 年 7 月期间,研究人员通过队列数据库、医疗记录和泰国国家艾滋病计划收集数据。在811名符合条件的AYA-PHIV中,93%存活;中位年龄为22.3岁(IQR为20.6-23.7),治疗持续时间为16.1年(IQR为13.4-18.0)。目前的艾滋病治疗由成人诊所(71%)和儿科诊所(29%)提供。治疗方案包括非核苷类逆转录酶抑制剂(55%)、蛋白酶抑制剂(36%)和整合酶抑制剂(8%);78%的患者在 15 岁时 HIV RNA 为 3,其死亡风险较高(调整后危险比为 6.16,95% CI 为 2.37-16.02)。总之,泰国青年艾滋病病毒感染者的高死亡率表明,在青年艾滋病病毒感染者向成年过渡的过程中,需要有更好的系统为其提供支持。
High mortality in adolescents and young adults with perinatally-acquired HIV in Thailand during the transition to adulthood.
Transitioning from pediatric to adult care remains a challenge for adolescents and young adults with perinatally-acquired HIV (AYA-PHIV). We assessed treatment outcomes and mortality among Thai AYA-PHIV. The study included AYA-PHIV who reached age 18-24 years who started antiretroviral treatment during childhood at five pediatric HIV clinics across Thailand. From November 2020-July 2021, data were gathered from a cohort database, medical records, and the Thai National AIDS Program. Of 811 eligible AYA-PHIV, 93% were alive; median age 22.3 years (IQR 20.6-23.7), treatment duration 16.1 years (IQR 13.4-18.0). Current HIV care was provided in adults (71%) and pediatric clinics (29%). Treatment regimens included non-nucleoside reverse transcriptase inhibitors (55%), protease inhibitors (36%), and integrase inhibitors (8%); 78% had HIV RNA <200 copies/ml. Of the 7.0% who died, median age at death was 20.8 years (IQR 20.6-22.1); 88% were AIDS-related death. Mortality after age 18 was 1.76 per 100-person years (95% confidence interval 1.36-2.28). Those with CD4 <200 cell/mm3 at age 15 had higher risk of mortality (adjusted hazard ratio 6.16, 95% CI 2.37-16.02). In conclusion, the high mortality among Thai AYA-PHIV indicated the need for better systems to support AYA-PHIV during the transition to adulthood.