Paediatric European Network for Treatment of AIDS (PENTA) Guidelines for Treatment of Paediatric HIV-1 Infection 2015

Optimizing Health in Preparation for Adult Life

A Bamford; A Turkova; H Lyall; C Foster; N Klein; D Bastiaans; D Burger; S Bernadi; K Butler; E Chiappini; P Clayden; M Della Negra; V Giacomet; C Giaquinto; D Gibb; L Galli; M Hainaut; M Koros; L Marques; E Nastouli; T Niehues; A Noguera-Julian; P Rojo; C Rudin; HJ Scherpbier; G Tudor-Williams; SB Welch

Disclosures

HIV Medicine. 2018;19(1):e1-e42. 

In This Article

Adolescence, Mental Health and Transition

Improved survival produced by ART, high rates of uptake of antenatal HIV screening and successful interventions reducing mother-to-child transmission have resulted in an aging European paediatric population, with many children born with HIV infection now transitioning to adult care. Transition has been defined as 'the planned purposeful process that addresses the medical, psychosocial and educational/vocational needs of adolescents and young adults with chronic physical and medical conditions as they move from child-centred to adult-oriented health care systems'.[217] In chronic diseases of childhood no single model of transition has been shown to be superior, although planned transition programmes improve attendance, disease control, self-management and patient and carer satisfaction. Data are emerging on the transition preferences of HIV-infected adolescents, with lack of confidence in negotiating adult services, stigma associated with HIV and fear of ending lifelong patient−carer relationships identified as barriers to transition.[218–220] Integrated paediatric and adult care in an age-specific environment, increasing autonomy, patient-centred timing of transition and comprehensive management explanations facilitate transition to adult care.

Data suggest that adolescents have poorer adherence to ART when compared with younger children.[221] In adolescents commencing first-line therapy, a boosted PI -based regimen potentially reduces the risk of accumulating resistance mutations in the event of virological failure; however, such regimens have a higher pill burden than the FDCs based on NNRTIs or EVG which have a lower genetic barrier to resistance. Adolescents who suppress on a boosted PI-based regimen can subsequently simplify to an FDC once adherence has been established.

It is increasingly acknowledged that HIV-infected young people have relatively high rates of mental health disorder.[98,222,223] Whether these are higher than in other patient groups with chronic medical conditions, HIV-exposed but uninfected siblings or well-matched healthy controls is yet to be fully determined.[222,224–226] Nevertheless, it is essential that the multidisciplinary team at least monitor for symptoms and signs of psychological distress and mental health disorder, as children progress into adolescence and young adult life. Early and ongoing support from clinical psychologists with specialist paediatric knowledge is recommended. The possibility of other interventions including the wider family and peer support should also be considered. Negotiating adolescence with any chronic disease may be difficult, but to do so with one potentially transmissible to future partners and offspring before one has explored one's own sexuality adds a layer of complexity, often compounded by stigma and secrecy associated with HIV.

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