{"id":1286,"date":"2017-05-03T16:35:58","date_gmt":"2017-05-03T15:35:58","guid":{"rendered":"https:\/\/blogs.bmj.com\/sti\/?p=1286"},"modified":"2017-05-03T16:35:58","modified_gmt":"2017-05-03T15:35:58","slug":"health-vulnerability-of-peri-natally-hiv-infected-youth-a-growing-problem-throughout-the-world","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/sti\/2017\/05\/03\/health-vulnerability-of-peri-natally-hiv-infected-youth-a-growing-problem-throughout-the-world\/","title":{"rendered":"Health vulnerability of peri-natally HIV-infected youth:  a growing problem throughout the world"},"content":{"rendered":"<p><span style=\"color: #000000;font-family: Times New Roman\">Mother-to-child, or \u2018vertical\u2019, transmission of HIV is not just a problem for developing countries; even in countries like the US and the UK, peri-natal transmission has probably not been eliminated.<\/span><span style=\"color: #000000;font-family: Times New Roman\">\u00a0 <\/span><span style=\"color: #000000;font-family: Times New Roman\">But, with routine \u2018opt-out\u2019 ante-natal testing (<\/span><a href=\"http:\/\/www.chiva.org.uk\/files\/3814\/2738\/8554\/bhiva-testing08.pdf\"><span style=\"color: #0563c1;font-family: Times New Roman\">BHIVA guidelines on HIV testing<\/span><\/a><span style=\"color: #000000;font-family: Times New Roman\">), cases are increasingly likely to involve births that have taken place overseas or before parental diagnosis (<\/span><a href=\"http:\/\/www.chiva.org.uk\/files\/2014\/2738\/8338\/testing-guidelines.pdf\"><span style=\"color: #0563c1;font-family: Times New Roman\">CHIVA guidelines on child testing<\/span><\/a><span style=\"color: #000000;font-family: Times New Roman\">) \u2013 cases that, for various reasons, may be difficult for health services to access (<\/span><a href=\"http:\/\/sti.bmj.com\/content\/91\/2\/76.full\"><span style=\"color: #0563c1;font-family: Times New Roman\">Editorial: &#8216;Don&#8217;t Forget the Children&#8217; (STI)<\/span><\/a><span style=\"color: #000000;font-family: Times New Roman\">). Yet, even with such events becoming less frequent, and the increasing survival of peri-natally HIV-infected youth (PHIVY) beyond infancy, there remains the problem of managing those already infected, as they transition, in growing numbers, from childhood into adolescence and young adulthood.<\/span><span style=\"color: #000000;font-family: Times New Roman\">\u00a0 <\/span><\/p>\n<p><span style=\"color: #000000;font-family: Times New Roman\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><span style=\"color: #000000;font-family: Times New Roman\">Such problems are very considerable, according to <\/span><a href=\"http:\/\/jamanetwork.com\/journals\/jamapediatrics\/article-abstract\/2613404\"><span style=\"color: #0563c1;font-family: Times New Roman\">Nailan &amp; Ciaranello<\/span><\/a><span style=\"color: #000000;font-family: Times New Roman\"> (N&amp;C) \u2013 especially for adolescents (13-17yrs) and young adults (18-30yrs).<\/span><span style=\"color: #000000;font-family: Times New Roman\">\u00a0 <\/span><span style=\"color: #000000;font-family: Times New Roman\">This recent study offers an analysis of data of PHIVY aged 7-30 years from two cohort studies in the US, the Pediatric HIV\/AIDS Cohort Study (PHACS) and the International Maternal Pediatric Adolescent AIDS Clinical Trials study (IMPAACT).<\/span><span style=\"color: #000000;font-family: Times New Roman\">\u00a0 <\/span><span style=\"color: #000000;font-family: Times New Roman\">As compared with the younger group (7-13 yrs), adolescents (13-18yrs) and young adults (18-30yrs) are likely to spend considerably more time with inadequate viral suppression (5% and 18% vs 2% with CD4 count <\/span><span style=\"color: #000000;font-family: Times New Roman\">&lt;<\/span><span style=\"color: #000000;font-family: Times New Roman\">200\/<\/span><span style=\"color: #000000;font-family: Times New Roman\">\u00b5<\/span><span style=\"color: #000000;font-family: Times New Roman\">L; 30% and 44% vs 22% with a viral load of <\/span><span style=\"color: #000000;font-family: Times New Roman\">\u2265<\/span><span style=\"color: #000000;font-family: Times New Roman\">400 copies\/mL), and to suffer correspondingly greater mortality (c.1 per 100 person-years amongst young adults) as well as HIV related events (c. 2 and 4 per 100 py. for CDC C and B category events amongst 18-30 yrs; c. 1 and 3 per 100 py. for CDC C and B category events amongst 13-18yrs).<\/span><span style=\"color: #000000;font-family: Times New Roman\">\u00a0 <\/span><span style=\"color: #000000;font-family: Times New Roman\">The authors attribute inadequate viral suppression, and high mortality\/morbidity, to poor adherence and retention in care.<\/span><span style=\"color: #000000;font-family: Times New Roman\">\u00a0 <\/span><\/p>\n<p><span style=\"margin: 0px;line-height: 107%;font-family: 'Calibri','sans-serif';font-size: 11pt\"><span style=\"color: #000000\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><span style=\"color: #000000\">The vulnerability of PHIVY as a group to poor health outcomes is not a problem unique to the US.<\/span><span style=\"color: #000000\">\u00a0 <\/span><span style=\"color: #000000\">In the UK c.1,950 PHIVY are monitored through the Collaborative HIV Pediatric Study (CHIPS) cohort, and the data indicate comparable problems of inadequate viral suppression (around one in ten (<\/span><a href=\"http:\/\/www.chiva.org.uk\/files\/2814\/8587\/2242\/CHIVA_Transition_Guidelines2017.pdf\"><span style=\"color: #0563c1\">CHIVA guidelines on transition<\/span><\/a><span style=\"color: #000000\">)).<\/span><span style=\"color: #000000\">\u00a0 <\/span><span style=\"color: #000000\">In some developing countries the health problems of this group are still more evident.<\/span><span style=\"color: #000000\">\u00a0 <\/span><a href=\"http:\/\/sti.bmj.com\/content\/88\/7\/525\"><span style=\"color: #0563c1\">De Matos &amp; dal Fabbro (STI)<\/span><\/a><span style=\"color: #000000\">, analysing the data for a cohort of 78 patients, aged 11-15 in 2009, from a municipality in Brazil, report five deaths, amongst other serious health events.<\/span><span style=\"color: #000000\">\u00a0 <\/span><span style=\"color: #000000\">More generally, the UNAIDS 2016 Report (<\/span><a href=\"https:\/\/blogs.bmj.com\/sti\/2016\/12\/07\/unaids-2016-report-how-a-life-cycle-approach-can-help-the-world-get-on-the-fast-track-to-hiv-prevention\/\"><span style=\"color: #0563c1\">The &#8216;life-cycle&#8217; approach (STI\/blogs)<\/span><\/a><span style=\"color: #000000\"> points, in the case of sub-Saharan Africa, to the recent tripling in peri-natally infected 15-19 yr olds who now account for 40% of all HIV-infected 15-19 yr olds in the region.<\/span><span style=\"color: #000000\">\u00a0 <\/span><span style=\"color: #000000\">Not only does poor adherence pose problems for PHIVY themselves; <\/span><a href=\"http:\/\/jamanetwork.com\/journals\/jamapediatrics\/article-abstract\/2613404\"><span style=\"color: #0563c1\">Nailan &amp; Ciaranello<\/span><\/a><span style=\"color: #000000\"> also draw attention to the danger they represent for society at large, given rates of pregnancy and risky sex that appear no lower than in the general population, along with heightened transmission risk resulting from poor viral suppression, and, in some cases, emerging drug resistance. <\/span><\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Mother-to-child, or \u2018vertical\u2019, transmission of HIV is not just a problem for developing countries; even in countries like the US and the UK, peri-natal transmission has probably not been eliminated.\u00a0 But, with routine \u2018opt-out\u2019 ante-natal testing (BHIVA guidelines on HIV testing), cases are increasingly likely to involve births that have taken place overseas or before [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/sti\/2017\/05\/03\/health-vulnerability-of-peri-natally-hiv-infected-youth-a-growing-problem-throughout-the-world\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":152,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[16504,2042,4369,2791],"tags":[],"class_list":["post-1286","post","type-post","status-publish","format-standard","hentry","category-children","category-hiv-care","category-hiv-retention-in-care","category-mother-to-child-hiv-transmission"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Health vulnerability of peri-natally HIV-infected youth: a growing problem throughout the world - Sexually Transmitted Infections<\/title>\n<meta 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