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Hospitalisation rates for youth living with perinatally acquired HIV in England
Sarah May Johnson1,2, Jhia Jiat Teh2, Thomas Joshua Pasvol3,4
1Department of Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London, United Kingdom.
Insights
Hospitalisation rates are significantly higher in adults over 20 years old compared to adolescents with perinatally acquired HIV (PaHIV). This highlights the need for ongoing multidisciplinary support for young people with PaHIV as they transition into adulthood.
Area of Science:
- Medical research
- Public health
- Infectious diseases
Background:
- Adolescents and adults living with perinatally acquired HIV (PaHIV) face unique health challenges.
- Hospitalisation rates in this population may be influenced by various factors.
- Understanding these challenges is crucial for improving care and support.
Purpose of the Study:
- To report hospitalisation rates in adolescents and adults with PaHIV in England.
- To identify predictive factors associated with hospitalisation in this cohort.
- To inform strategies for enhanced support and care.
Main Methods:
- Retrospective observational cohort study (2016-2019).
- Data included hospitalisation details, HIV viral load, and CD4 counts.
- Negative binomial regression was used to analyze admission rates and predictive factors.
Main Results:
- The cohort included 255 patients with 689 person-years of follow-up.
- Hospitalisation incidence was 9.0 per 100 person-years, increasing significantly in adults (>20 years).
- Low CD4 counts (<200 cells/uL) and a history of CDC-C diagnosis were significant predictors of admission.
Conclusions:
- Hospitalisation rates were four times higher in adults (>20 years) compared to adolescents (10-19 years).
- HIV-related conditions accounted for the majority of admissions.
- Enhanced multidisciplinary support is essential for PaHIV youth transitioning into adulthood.
Introduction:
Complex challenges amongst ageing cohorts of adolescents and adults living with perinatally acquired HIV (PaHIV) may impact on hospitalisation. We report hospitalisation rates and explored predictive factors for hospitalisation in adolescents and adults (10-35 years) living with PaHIV in England.
Method:
Retrospective observational cohort study over a three-year period 2016-2019. Data collected included cause and duration of hospitalisation, HIV viral load and CD4 lymphocyte count. The primary outcome was overnight hospitalisation. Patients exited at study end/ transfer of care (TOC)/ loss to follow up (LTFU) or death. Maternity/hospital admissions at other centres were excluded. Admission rates per 100 person-years (95% CI) were calculated by age group. Negative binomial regression with generalized estimating equations was performed.
Results:
255 patients contributed 689 person-years of follow up. 56% were female and 83% were of a Black, Black British, Caribbean or African ethnicity. At baseline, the median age was 19 years (IQR 16-22). 36 individuals experienced a total of 62 admissions which resulted in 558 overnight stays (median stay was 5 nights). One person died (lymphoma), six had TOC and one was LTFU by the end of the three-year study period. Crude incidence of admission for the whole cohort was 9.0 per 100 PY (6.9-11.6). The respective crude incidence rates were 1.5 PY (0.0-8.2) in those aged 10-14 years and 3.5 PY (1.5-7.0) in the 15-19-year-olds. In those aged 20-24 years it was 14.5 PY (10.1-20.2) and in those >25 years the crude incidence rate was 11.7 PY (6.9-18.5). Factors significantly associated with admission were a CD4 lymphocyte count <200 cells/uL, adjusted IRR 4.0 (1.8-8.8) and a history of a CDC-C diagnosis, adjusted IRR 2.9 (1.6-5.3). 89% admissions were HIV-related: 45% new/current CDC-C diagnoses, 76% due to infection.
Conclusions:
Hospitalisation rates were four-fold higher in adults (>20 years of age) compared to adolescents (10-19-year-olds). The continuing challenges experienced by PaHIV youth require enhanced multidisciplinary support throughout adulthood.
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