High levels of engagement in care by children and young people with HIV in the UK and Ireland

By | October 10, 2019

There are good results for the paediatric cascade of care in the UK and Ireland, researchers report in the Journal of the International AIDS Society. Almost all young people have some engagement with care, 92% are taking HIV treatment and 86% are virologically suppressed. The uptake of treatment increased between 2010 and 2016, but the proportion who are virologically suppressed did not.

Very few studies have described the cascade of care in children with HIV in high-income countries. The report comes from the national Collaborative HIV Paediatric Study (CHIPS), which has been running since 2000. However, continued funding for this cohort is currently under threat.

The study includes data on all children and young people enrolled in paediatric HIV services in the UK and Ireland in 2010, 2013 and 2016. There were 1249 eligible young people in the cohort in 2010, falling to 905 in 2016.

Glossary

virological suppression

Halting of the function or replication of a virus. In HIV, optimal viral suppression is measured as the reduction of viral load (HIV RNA) to undetectable levels and is the goal of antiretroviral therapy.

loss to follow up

In a research study, participants who drop out before the end of the study. In routine clinical care, patients who do not attend medical appointments and who cannot be contacted.

CD4 cell percentage

The CD4 cell percentage measures the proportion of all white blood cells that are CD4 cells.

Young people left the cohort mostly because they transferred to adult care. Smaller numbers of former cohort members were not included in the analysis because they had died, moved abroad, were lost to follow up or were over the age of 21.

Almost all members of the cohort had been living with HIV since birth, just over half were female, and 80% were of black African ethnicity. Half were born abroad – most of this group were seen by an HIV service within a year of their arrival in the UK, most often between four and ten years of age.

The median age of starting treatment was five years, with half of all children starting between one and ten years.

The cascade of care in 2016 was as follows:

  • In active care: 98%
  • Of those in care, taking HIV treatment: 92%
  • Of those taking treatment, an undetectable viral load (below 200): 86%.

Of those on treatment, 87% had a good immune status (a CD4 cell count over 350 in those aged five or over, or good CD4 percentage in younger children).

The uptake of HIV treatment increased significantly over time, from 79% in 2010 to 92% in 2016. However, significant changes in the other indicators were not seen over time.

Engagement with care was better for younger children than for older adolescents. Those over the age of 15 years were less likely to have an undetectable viral load (79% vs. 91%) or have good immune status (78% vs. 94%). This highlights the need for targeted support for this age group, the researchers say.

Looking at children and young people not on treatment, one third had stopped taking it, usually because of adherence difficulties. Their median age was 16 years.

On the other hand, two-thirds of those not on antiretroviral therapy had never taken it. They tended to be younger (median 12) and were mostly clinically well, with high CD4 counts (median 668).

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