Kapogiannis et al, IAS 2015, abstract WELBPE16.
While teens and young adults are just as likely as older people to be linked to care after being diagnosed with HIV, less than a third of them were retained in care or started antiretroviral therapy (ART), and only 7% achieved undetectable viral load - much lower than the rate of older people, the researchers reported in 8.ª International AIDS Society Conference on HIV pathogenesis, treatment and prevention Last month in Vancouver. Immediate referral to the young A FRIENDLY SERVICES however, increased the likelihood of viral suppression.
Bill Kapogiannis of Health National Institute of Child and Human Development and his fellow researchers with the Collaborative SMILE looked continuum of care to HIV for young people with HIV. SMILE (Multisite Strategic Initiative for identification, coordination and involvement in the care of young people diagnosed with HIV) is a collaboration between adolescent medicine at the National Network of trials for interventions on HIV / AIDS (ATN), resources health and Services Administration (HRSA) and the Centers for Disease Control and Prevention (CDC).
TheContinuum or call cascadeRefers to the sequence of steps in HIV testing and diagnosis, the joint care, the beginning of treatment, to achieve viral suppression. Researchers at the public health track progress in treating the epidemic when looking at how many people "get lost" or fall out of care at every stage.
About a quarter of all new cases of HIV infection in the United States occur among young people aged 13-24 years, the researchers noted as background, but it is not just specific to youth data on involvement in care .
The CDC estimates that 86% of 1,2 million people living with HIV in the US have been tested and know their status, dropping to 49% among young people aged 18-24, according to what appears reported on 2011 year and the numbers reported in28 2014 OF NOVEMBERmortality and morbidity Weekly Report.
The SMILE study initiated in the next stage of the continuum, looking at the results between 1548 young age 12-24, which were diagnosed with HIV and identified by collaboration between October and September 2012 2014. Among the 733 participants with available data, 81% were male and 72% were black, 70% identified as gay or bisexual, the average age of 20,6 years, and the mean T-CD4 cell count was 463 cells / mm3.
The researchers determined the number of participants who were referred to the service, associated with care (within a period of 42 days after shipping), working in care (defined as at least 1 additional visit within 16 weeks after joint) , kept in service (at least 1 additional visit in 52 weeks of engagement), and held viral suppression or undetectable HIV RNA in plasma.
- Total 1548 participants diagnosed with HIV, 1053 number (68%) have recently been linked to health care.
- Of these, 839 participants (80%) were involved in the service, and among those, 473 (56%) were maintained in attendance.
- Looking up as a proportion of the total initial diagnosed with HIV - not just for those who have attained the previous step in the continuum - 54% were linked to health care, 31% were kept in service, 31% started HAART and 7% had achieved undetectable viral load.
- Among the 358 people who were not connected to successfully care, the main reasons were repeated failures to attend appointments (34%), inability to locate the participant (32%), participant attendance refusal (11%), and competence of service (11%).
- At the time of connection to the service, 38% had a count of CD4 cells above 500 cells / mm3, 29 350-500% had 350-500 350-500 cells / mm3And 34% had less than 350 cells / mm3.
- As the participants reached the successive steps of the continuous care, the average viral load gradually decreases, while the proportion of RNA undetectable HIV increased.
- Significant predictors of viral suppression in an analysis set included lower viral load at the time of connection to the service, the recent use of ART (adjusted to 3,10 risk average, or more than 3 times higher), and a shorter interval between Tests and routing for joint care (adjusted HR 1,64 by 0-7 days 2,52 7 days to weeks 6 and 2,08 to 6 3 weeks to months, as compared with more than 3 months).
The 7% viral suppression rate seen in this analysis is surprisingly low - substantially less than about 40% of all age groups combined with medical management of CDC Project seconds Report July 2015 the additional surveillance
"The collaborative SMILE study has shown that young people infected with HIV had high levels of plasma viremia and advanced disease at diagnosis, which have implications progression of the disease and potential transmission," the researchers concluded. "As long as they are connected to the service at similar rates as adults, young hit show disproportionately low rates of virologic suppression."
"Ready youth-friendly shipping the articulation of health services after HIV testing is an independent predictor of suppression of viral load," he continued. "Recent developments affecting the urgency of starting antiretroviral treatmentFor people with HIV have direct implications for youth who now have even less time to adapt to his new diagnosis. This argues for more research and services to address critical issues such treatment availability and adherence to medication among newly infected youth. "
Translated into 30 / 11 / 2015 the 03: 07 the originalIAS 2015: HIV + Youth Are Less Likely than Adults to Achieve Viral Suppression on ART(link opens in another site, in English) by Claudio Souza. Reviewed by Mara Macedo on 30 / 11 / 2013