Kapogiannis et al, A IAS 2015, abstract WELBPE16.
While adolescents and young adults are as susceptible as the elderly to care for after being diagnosed with HIV, less than a third of them have been retained in care or initiated antiretroviral therapy (ART), and only 7% have reached undetectable viral load - much lower than the rate of older individuals, researchers reported at the 8.ª International AIDS Society conference on HIV pathogenesis, treatment and prevention last month in Vancouver. Early referral to young people FRIENDLY SERVICES however, increased the likelihood of viral suppression.
Bill Kapogiannis of the National Institute of Child Health and Human Development and his fellow researchers with SMILE Collaborative looked at HIV care continuum for young people with HIV. SORRISO (Multisite Strategic Initiative for the identification, articulation and involvement in the care of young people diagnosed with HIV infection) is a collaboration between Adolescent Medicine in the National Network of Essays for interventions on HIV / AIDS (ATN), resources Health and Services Administration (HRSA), and the Centers for Disease Control and Prevention (CDC).
O Continuum or cascade of care It refers to the sequence of stages of HIV testing and diagnosis, articulation in care, initiation of treatment, to achieve viral suppression. Public health researchers track progress in treating the epidemic by looking at how many people "get lost" or fall out of care at each stage.
About a quarter of all new cases of HIV infection in the United States occur among young age group 13-24 years, researchers noted as background, but there is little specific to youth data on involvement in care .
The CDC estimates that 86% of the 1,2 million people living with the HIV virus in the US have been tested and know their condition, falling to 49% among the young age group 18-24, according to what is reported on the year of 2011 and the numbers reported in 28 2014 NOVEMBER mortality and morbidity Weekly report.
The SMILE study started in the next step of the continuum, looking at the results among young 1548, age group 12-24, who were diagnosed with HIV and identified by the collaboration between 2012 October and 2014 September. Among the 733 participants with the available data, 81% were male and 72% were black, 70% identified as gay or bisexual, mean age was 20,6 years, and the mean T-CD4 cell count was 463 cells / mm3.
The researchers determined the number of participants who were referred for care associated with care (within 42 days after submission), working on care (defined as at least 1 additional visit within 16 weeks after articulation) , maintained in the attendance (at least 1 additional visit in 52 weeks of engagement), and performed viral suppression or undetectable plasma HIV RNA.
- Total 1548 participants diagnosed with HIV, number 1053 (68%) were recently linked to health care.
- Of these, 839 participants (80%) were involved in the care, and among these, 473 (56%) were kept in care.
- Looking up in terms of proportion of the initial total diagnosed with HIV - not only for those who reached the previous stage on the continuum - 54% were linked to health care, 31% were maintained in care, 31% started HAART and 7% had undetectable viral load.
- Among the 358 people who were not connected to successful care, the main reasons were repeated failure to attend appointments (34%), inability to locate the participant (32%), refusal of attendance of the participant (11%), and service competency (11%).
- At call time, 38% had a CD4 cell count above 500 cells / mm3, 29% had 350-500 350-500 350-500 cells / mm3, and 34% had less than 350 cells / mm3.
- As participants reached successive stages of continuous care, the mean viral load progressively declines, while the proportion of undetectable HIV RNA increased.
- Significant predictors of viral suppression in an adjusted analysis included lower viral load at the time of attachment for care, recent use of ART (adjusted for 3,10 risk, or greater than 3 times greater), and a shorter interval between testing and routing for joint care (adjusted HR 1,64 for 0-7 days, 2,52 for 7 days for 6 weeks, and 2,08 for 6 weeks for 3 months, compared to over 3 for months).
The 7% viral suppression rate saw in this analysis is surprisingly low - substantially less than about 40% of all age groups combined with CDC medical follow-up Project according to 2015 July supplementary surveillance report
"The collaborative SMILE study has shown that HIV-infected youngsters have high levels of plasma viremia and advanced infection at the time of diagnosis, which have implications for disease progression and potential transmission," the researchers concluded. "While they are linked to care at similar rates as adults, young people attained show disproportionately low rates of virologic suppression."
"The prompt delivery of youth-friendly articulation of health services after HIV testing is an independent predictor of suppression of viral load," he continued. "Recent developments affecting the urgency of initiating antiretroviral treatment For people infected with HIV they have direct implications for the youth who now have even less time to adapt to their new diagnosis. This argues for further research and services to address such critical issues of treatment availability and adherence to medication among newly infected youth. "
Translated into 30 / 11 / 2015 the 03: 07 of the original in IAS 2015: HIV + Youth Are Less Likely than Adults to Achieve Viral Suppression on ART (link opens in another site, in English) by Cláudio Souza. Reviewed by Mara Macedo on 30 / 11 / 2013