title: Virtual support for paediatric HIV treatment decision making.
abstract: OBJECTIVE
  The objective of this study is to review clinical outcomes of recommendations made by a multidisciplinary paediatric virtual clinic (PVC) for complex case management of paediatric HIV as a model of care within a tertiary network.
  
  
  METHODS
  A retrospective review of the clinical outcomes of paediatric and adolescent (0-21 years) referrals to the PVC at St. Mary's Hospital, Imperial College Healthcare NHS Trust, London was performed between October 2009 and November 2013.
  
  
  RESULTS
  234 referrals were made for 182 children from 37 centres, discussed in 42 meetings (median age 13 years, IQR 10-15 years). Reasons for referral included virological failure (44%), simplification of the current regimen (24%) and antiretroviral drug complications (24%). At latest follow-up, PVC advice had been instituted in 80% of referrals. Suppression following virological failure was achieved in 48% following first referral and 57% following subsequent discussions and was maintained in 95% of children referred for regimen simplification. Following advice, dyslipidaemia resolved in 42% and liver function normalised in 73% with biochemical hepatitis. Adherence support aided resolution of viraemia in nine children and 12% of referrals resulted in additional support, including psychology, social services and mental health input.
  
  
  CONCLUSIONS
  Combined multidisciplinary virtual input with adult expertise in resistance and newer agents, paediatric knowledge of pill swallowing, childhood formulations/weight banding and parental support, assists complex treatment decision making in paediatric HIV infection. The Virtual Clinic model could be applied to the management of other rare complex diseases of childhood within a clinical network.
authors.affiliation: St. Mary's Hospital, Imperial College NHS Trust, London, UK Department of Paediatrics, Imperial College London, London, UK.
authors.forename: Kirsty
authors.initials: K
authors.lastname: Le Doare
authors.affiliation: St. Mary's Hospital, Imperial College NHS Trust, London, UK.
authors.forename: N E
authors.initials: NE
authors.lastname: Mackie
authors.affiliation: St. Mary's Hospital, Imperial College NHS Trust, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Kaye
authors.affiliation: St. Mary's Hospital, Imperial College NHS Trust, London, UK Great Ormond Street Hospital, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Bamford
authors.affiliation: St. Mary's Hospital, Imperial College NHS Trust, London, UK Department of Paediatrics, Imperial College London, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Walters
authors.affiliation: St. Mary's Hospital, Imperial College NHS Trust, London, UK.
authors.forename: C
authors.initials: C
authors.lastname: Foster
mesh_terms: D000293:Adolescent; D023241:Antiretroviral Therapy, Highly Active; D002648:Child; D003657:Decision Making; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D033183:Interdisciplinary Communication; D008131:London; D012017:Referral and Consultation; D012189:Retrospective Studies; D017216:Telemedicine / Q000379:methods*; D017211:Treatment Failure; D016896:Treatment Outcome
keywords: HIV; Information Technology; Pharmacology