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Complexities and challenges of transition to adult services in adolescents with vertically transmitted HIV infection
  1. Ruth Harris
  1. Medical Student, MBBS Year 5, King's College London, London, UK
  1. Correspondence to Ms Ruth Harris, King's College London, London SE1 1UL, UK; ruth.e.harris{at}kcl.ac.uk

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Background

Increasing numbers of HIV-positive young people are transitioning from paediatric to adult services. According to the latest Collaborative HIV Paediatric Study (CHIPS) report1 there are 1873 children with vertically acquired HIV (HIV acquired by mother-to-child transmission) in UK and Ireland, with 595 young people transitioning to adult services. There have been 50–100 young people transferring each year between 2007 and 2013, with a median age of 17.5 (interquartile range 16.6–18.3) years.1 Those aged >15 years have increased from <1% in 1996 to 40% in 2012.1 The development of this vulnerable new patient group means that health care services providers and planners need to take into account the changing needs of these young people living into adulthood with HIV.

High uptake of antenatal testing, access to highly active antiretroviral treatment (HAART) and effective intervention in preventing mother-to-child transmission in well-resourced countries such as the UK means that perinatally acquired HIV rates are very low. Young people growing up with vertically transmitted HIV in the UK are predominantly of sub-Saharan African origin and born outside the UK.1 There is a trend towards increasing age of newly diagnosed HIV-positive children living in the UK but born abroad, because it has become apparent that 1 in 10 of infected children are predicted to survive without treatment up to 10 years of age.2 These are the evolving reasons for the growing number of children and young people with vertically transmitted HIV in the UK.

The development of effective treatment means that children with vertically acquired HIV are now expected to survive beyond childhood. According to a report by the Antiretroviral Therapy Cohort Collaboration3 involving meta-analysis of 14 cohorts of HIV-positive adolescents, a 20-year-old starting antiretroviral treatment could expect to live an additional 43 years. The success of HAART and the recognition of …

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