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P174 Clinical outcomes in adolescents with perinatally acquired HIV (PAH) transitioning from paediatric to adult care in a large regional HIV clinic in london
  1. Aime Hibbard1,
  2. Kate Flanaghan2,
  3. Ali Judd3,
  4. Katia Prime2
  1. 1St George’s University of London, London, UK
  2. 2St George’s University NHS Foundation Trust, London, UK
  3. 3MRC Clinical Trials Unit, UCL, London, UK

Abstract

Introduction We assessed outcomes in PaH adolescents transitioning from paediatric to adult care within a regional HIV clinic.

Methods Retrospective case-note review 10/02/04–31/12/15. Data collected: demographics, CDC stage, viral loads (VL), CD4 counts, antiretroviral therapy (ART), resistance and loss to follow up; using a standardised database. Pre- and post-transition outcomes were compared using paired T-tests for means and McNemar’s Exact tests for proportions.

Results 57 patients; 29(51%) male, 34(60%) born outside UK, 51(89%) black African. Median age at diagnosis 3 years [range 0–18]; at transition 18 years [15–20]. Median time since transition 5 years [1 month–13 years]. At transition CDC B 27/57(47%), CDC C 18/57(32%), post transition 28/57(49%), 20/57(35%), respectively, including one suicide. Of those with ≥2 years data post-transition, 31/48(65%) had two consecutive VL>40c/mL or one VL>10,000c/mL in the 2 years pre-transition, compared with 22/48(46%) post-transition (p=0.035). Mean CD4 count 12 months pre/post-transition 520 c/mm3, 500 c/mm3, respectively (p=0.4). At transition 52/57(91%) on ART (vs. 55(96%) at last visit, p=0.1), 10/46(22%) 1st line (5/55(9%) last visit), median duration of ART 7 years [0–18]. Resistance: 18/46(39%) nil, 13/46(28%) ≥1, 13/46(28%) ≥2, 1/46(2%) ≥3 drug classes. 4 patients were lost to follow-up (LTFU), all returning within 5 years [1-5].

Discussion There was no difference in mean CD4 pre or post-transition, but the proportion who were suppressed improved post-transition. CDC stage progressed in 3 adolescents. All patients had options for suppressive ART although few were on 1st line. There was no long-term LTFU.

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