Background: Transitioning from pediatric to adult HIV care is critical for adolescents and young adults living with HIV (AYLH). This study assessed the timing and factors associated with this transition in Asia.
Setting: Retrospective study of AYLH enrolled in TREAT Asia Pediatric HIV Observational Database clinics between May 1991-December 2020.
Methods: Eligible AYLH were categorized into <18-year-old transitions, and ≥18-year-old transitions or continued pediatric care.
Results: The analysis included 1,803 AYLH from six countries. Of these, 92.7% (n=1,672) had perinatally acquired HIV, and 69.9% (n=1,260) were >18-year-old transitions or continued pediatric care. Excluding AYLH who remained in pediatric care, median age at transition was 16.1 years (IQR: 14.9-17.0) for <18-year-old transitions and 20.0 years (IQR: 19.1-21.2) for ≥18-year-old transitions. At age 18, among 1,368 AYLH with available viral load data, 72.9% (n=998) had viral loads <50 copies/mL (78.9% in <18-year-old transitions [n=310/393] vs 70.6% in ≥18-year-old transitions [n=688/975]; P=0.002). Median CD4 count was 635 cells/μL (IQR: 450-842). Factors independently associated with transitions at ≥18 years old or continued pediatric care included residence in a high-middle-income country (aOR 10.68 [95%CI: 7.76, 14.68], P<0.001), living with family (aOR 2.81 [95%CI: 1.99, 3.97], P<0.001), and prior ART class switching (aOR 1.91 [95%CI: 1.34, 2.72], P<0.001).
Conclusion: Most AYLH in this cohort transitioned at ≥18. About one-fourth had unsuppressed viral loads at age 18, irrespective of transition status, underscoring the need for personalized treatment approaches that support ART adherence from pediatric care, preparing AYLH for transition to adult clinics.
Keywords: Adolescent; Asia; HIV; Transitioned Care; Youth.
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