Transition from paediatric to adult care among persons with perinatal HIV infection in New York City, 2006–2015

Abstract

Objective: The aim of this study was to evaluate the transition process from paediatric to adult care among persons with perinatal HIV infection in New York City (NYC). Design: A retrospective prepost study and a matched exposed/unexposed nested cohort study. Methods: Using data from the NYC HIV registry, a retrospective prepost study was performed among persons who transitioned from paediatric to adult care to assess pre and posttransition retention in care (1 CD4þ cell count/viral load in a 12-month period), CD4þ cell count and viral suppression (200 copies/ml). A 1: 3 matched exposed/unexposed nested cohort study was conducted to assess pre and posttransition 1-year mortality by matching persons who transitioned to adult care and persons who remained in paediatric care on calendar year (1 year) and age at transition (1 year). Results: A total of 735 persons with perinatal HIV infection transitioned to adult care in NYC during 2006 – 2015, of whom 53.9% were women, 57.7% black and 37.1% Hispanic. Pretransition (Year 0), and posttransition Year 1, Year 2 and Year 3 proportions of persons with CD4þ cell count at least 500 cells/ml were 35.2, 38.3, 38.9 and 39.0%, respectively, and viral suppression were 45.9, 48.6, 51.1 and 51.8%, respectively. One-year mortality rates before and after transition were 2.3/1000 and 55.8/ 1000, respectively. Conclusion: Persons with perinatal HIV infection in NYC who transitioned from paediatric to adult care saw improvements in CD4þ cell count and viral suppression after transition. The increase in mortality after transition was likely caused by the conditions before or leading to the transition.