title: Virological and Social Outcomes of HIV-Infected Adolescents and Young Adults in The Netherlands Before and After Transition to Adult Care.
abstract: As a result of effective combination antiretroviral therapy (cART) and advanced supportive healthcare, a growing number of human immunodeficiency virus (HIV)-infected children survive into adulthood. The period of transition to adult care is often associated with impaired adherence to treatment and discontinuity of care. We aimed to evaluate virological and social outcomes of HIV-infected adolescents and young adults (AYAs) before and after transition, and explore which factors are associated with virological failure.
  
  
  
  We included 59 HIV-infected AYAs from the Netherlands who had entered into pediatric care and transitioned from pediatric to adult healthcare. We used HIV RNA load and cART data from the Dutch Stichting HIV Monitoring database (1996-2014), and collected social and treatment data from patients' medical records from all Dutch pediatric HIV treatment centers and 14 Dutch adult treatment centers involved. We evaluated risk factors for virological failure (VF) in a logistic regression model adjusted for repeated measurements.
  
  
  
  HIV VF occurred frequently during the study period (14%-36%). During the transition period (from 18 to 19 years of age) there was a significant increase in VF compared with the reference group of children aged 12-13 years (odds ratio, 4.26 [95% confidence interval, 1.12-16.28]; P = .03). Characteristics significantly associated with VF were low educational attainment and lack of autonomy regarding medication adherence at transition.
  
  
  
  HIV-infected AYAs are vulnerable to VF, especially during the transition period. Identification of HIV-infected adolescents at high risk for VF might help to improve treatment success in this group.
authors.affiliation: Department of Pediatric Infectious Diseases, Emma Children's Hospital, Academic Medical Centre AMC.
authors.forename: Annouschka M
authors.initials: AM
authors.lastname: Weijsenfeld
authors.affiliation: HIV Monitoring Foundation.
authors.forename: Colette
authors.initials: C
authors.lastname: Smit
authors.affiliation: Department of Pediatric Infectious Diseases, Emma Children's Hospital, Academic Medical Centre AMC.
authors.forename: Sophie
authors.initials: S
authors.lastname: Cohen
authors.affiliation: HIV Monitoring Foundation.|Department of Infectious Diseases, Academic Medical Center AMC, Amsterdam.
authors.forename: Ferdinand W N M
authors.initials: FWNM
authors.lastname: Wit
authors.affiliation: Department of Infectious Diseases, Academic Medical Center AMC, Amsterdam.
authors.forename: Michelle
authors.initials: M
authors.lastname: Mutschelknauss
authors.affiliation: Department of Pediatrics, Division of Infectious Diseases and Immunology, Erasmus Medical Centre-Sophia Children's Hospital.
authors.forename: Linda C
authors.initials: LC
authors.lastname: van der Knaap
authors.affiliation: Department of Infectious Diseases, Erasmus Medical Centre, Rotterdam.
authors.forename: Laura M
authors.initials: LM
authors.lastname: van Zonneveld
authors.affiliation: Department of Infectious Diseases, Radboud University Medical Centre, Nijmegen.
authors.forename: Bert J
authors.initials: BJ
authors.lastname: Zomer
authors.affiliation: Department of Pediatric Infectious Diseases, Wilhelmina Children's Hospital.
authors.forename: Nike
authors.initials: N
authors.lastname: Nauta
authors.affiliation: Department of Internal Medicine and Infectious Diseases, University Medical Centre UMC, Utrecht.
authors.forename: Joke C
authors.initials: JC
authors.lastname: Patist
authors.affiliation: Department of Infectious Diseases, Elisabeth Hospital, Tilburg.
authors.forename: Marien H J
authors.initials: MHJ
authors.lastname: Kuipers-Jansen
authors.affiliation: Department of Infectious Diseases, Maasstad Hospital, Rotterdam, The Netherlands.
authors.forename: Esther P
authors.initials: EP
authors.lastname: Smit
authors.affiliation: Department of Pediatric Infectious Diseases, Emma Children's Hospital, Academic Medical Centre AMC.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Blokhuis
authors.affiliation: Department of Pediatric Infectious Diseases, Emma Children's Hospital, Academic Medical Centre AMC.
authors.forename: Dasja
authors.initials: D
authors.lastname: Pajkrt
authors.forename: A M
authors.initials: AM
authors.lastname: Weijsenfeld
authors.forename: S
authors.initials: S
authors.lastname: Cohen
authors.forename: C
authors.initials: C
authors.lastname: Blokhuis
authors.forename: A
authors.initials: A
authors.lastname: van der Plas
authors.forename: H J
authors.initials: HJ
authors.lastname: Scherpbier
authors.forename: M
authors.initials: M
authors.lastname: Mutschelknauss
authors.forename: F J B
authors.initials: FJB
authors.lastname: Nellen
authors.forename: J M
authors.initials: JM
authors.lastname: Prins
authors.forename: D
authors.initials: D
authors.lastname: Pajkrt
authors.forename: C
authors.initials: C
authors.lastname: Smit
authors.forename: F W N M
authors.initials: FWNM
authors.lastname: Wit
authors.forename: P
authors.initials: P
authors.lastname: Reiss
authors.forename: L
authors.initials: L
authors.lastname: van der Knaap
authors.forename: E
authors.initials: E
authors.lastname: Visser
authors.forename: L M
authors.initials: LM
authors.lastname: van Zonneveld
authors.forename: M E
authors.initials: ME
authors.lastname: Vriesde
authors.forename: N Y
authors.initials: NY
authors.lastname: Bassant
authors.forename: M E
authors.initials: ME
authors.lastname: van der Ende
authors.forename: A M C
authors.initials: AMC
authors.lastname: van Rossum
authors.forename: G J A
authors.initials: GJA
authors.lastname: Driessen
authors.forename: P L A
authors.initials: PLA
authors.lastname: Fraaij
authors.forename: J V
authors.initials: JV
authors.lastname: Smit
authors.forename: E P
authors.initials: EP
authors.lastname: Smit
authors.forename: M P W
authors.initials: MPW
authors.lastname: Kastelijns
authors.forename: J G
authors.initials: JG
authors.lastname: den Hollander
authors.forename: K
authors.initials: K
authors.lastname: Pogány
authors.forename: C
authors.initials: C
authors.lastname: Moons
authors.forename: F P
authors.initials: FP
authors.lastname: Kroon
authors.forename: E
authors.initials: E
authors.lastname: Oude Geerdink
authors.forename: I B
authors.initials: IB
authors.lastname: van der Meche
authors.forename: W E M
authors.initials: WEM
authors.lastname: Schouten
authors.forename: K
authors.initials: K
authors.lastname: Brinkman
authors.forename: G
authors.initials: G
authors.lastname: Ter Beest
authors.forename: E H
authors.initials: EH
authors.lastname: Gisolf
authors.forename: C
authors.initials: C
authors.lastname: Richter
authors.forename: B J
authors.initials: BJ
authors.lastname: Zomer
authors.forename: R
authors.initials: R
authors.lastname: Strik-Albers
authors.forename: M
authors.initials: M
authors.lastname: van der Flier
authors.forename: S S
authors.initials: SS
authors.lastname: Henriet
authors.forename: P P
authors.initials: PP
authors.lastname: Koopmans
authors.forename: J C
authors.initials: JC
authors.lastname: Patist
authors.forename: N
authors.initials: N
authors.lastname: Nauta
authors.forename: S P M
authors.initials: SPM
authors.lastname: Geelen
authors.forename: T F W
authors.initials: TFW
authors.lastname: Wolfs
authors.forename: I M
authors.initials: IM
authors.lastname: Hoepelman
authors.forename: T
authors.initials: T
authors.lastname: Mudrikova
authors.forename: P A
authors.initials: PA
authors.lastname: van der Meulen
authors.forename: H
authors.initials: H
authors.lastname: de Jonge
authors.forename: E H
authors.initials: EH
authors.lastname: Scholvink
authors.forename: W F W
authors.initials: WFW
authors.lastname: Bierman
authors.forename: J F
authors.initials: JF
authors.lastname: van den Berg
authors.forename: J W
authors.initials: JW
authors.lastname: Bouwhuis
authors.forename: S
authors.initials: S
authors.lastname: Faber
authors.forename: M
authors.initials: M
authors.lastname: van Vonderen
authors.forename: J A
authors.initials: JA
authors.lastname: Schippers
authors.forename: S H
authors.initials: SH
authors.lastname: Lowe
authors.forename: M H J
authors.initials: MHJ
authors.lastname: Kuipers-Jansen
authors.forename: M E E
authors.initials: MEE
authors.lastname: van Kasteren
authors.forename: A E
authors.initials: AE
authors.lastname: Brouwer
authors.forename: D C
authors.initials: DC
authors.lastname: Pronk
authors.forename: W
authors.initials: W
authors.lastname: Kortmann
mesh_terms: D000293:Adolescent; D000367:Age Factors; D023241:Antiretroviral Therapy, Highly Active; D002648:Child; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000635:transmission / Q000821:virology; D006801:Humans; D059012:Lost to Follow-Up; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D016017:Odds Ratio; D012307:Risk Factors; D012959:Socioeconomic Factors; D060305:Transition to Adult Care; D017211:Treatment Failure; D016896:Treatment Outcome; D055815:Young Adult
keywords: HIV; adolescents; transition; virological outcomes; young adults