Sexual and reproductive health needs of young women living with perinatally acquired HIV.

BACKGROUND: Increasingly, young women living with perinatally acquired HIV (YWLPaHIV) have transitioned from paediatric to adult services. There remains a paucity of data on the sexual and reproductive health (SRH) needs of YWLPaHIV and their access to youth-friendly care. Amidst healthcare changes due to COVID-19 pandemic restrictions, we explored SRH needs of a cohort of YWLPaHIV. METHODS: Evaluation of SRH needs of YWLPaHIV attending a UK NHS-youth HIV service with data collected from patient records and self-reported questionnaires amongst women attending between July and November 2020 following easing of the first lockdown and reintroduction of in-person appointments. RESULTS: 71 of 112 YWLPaHIV registered at the clinic completed questionnaires during the study period and were included in the analysis. Median age was 23 y (IQR 21-27, range 18-36). 51/71(72%) reported coitarche, average age 17.6 y (IQR 16-18, range 14-24). 24 women reported 47 pregnancies resulting in 16 (34%) HIV-negative live-births, 19 (40%) terminations, 9(19%) miscarriages, with 3 pregnancies ongoing. 31/48(65%) sexually active women reported current contraception: 10 (32%) condoms, 19 (62%) long-acting, and 3(10%) oral contraceptive pill. 18/51(35%) reported a previous sexually transmitted infection; human papillomavirus (HPV) (11), Chlamydia trachomatis (9) and herpes simplex (2). 27/71(38%) women had undergone cervical cytology including 20/28(71%) women aged ≥25 y with abnormalities documented in 29%. HPV vaccination was reported in 83%, with protective hepatitis B titres in 71%. CONCLUSION: High rates of unplanned pregnancy, STIs and cervical abnormalities highlight the continuing SRH needs of YWLPaHIV and requirement for open access to integrated HIV/SRH services despite pandemic restrictions.

Impact of SARS-CoV-2 pandemic on viral suppression for young adults living with perinatally acquired HIV infection.

We compared virological and immunological outcomes for young adults with perinatally-acquired HIV infection (YAPaHIV) in the year preceding, and year of, UK SARS-CoV-2 lockdown restrictions, in a service that maintained face-to-face appointments. Retrospective single-centre cohort analysis from; Period 1(P1) twelve months before the first national lockdown - 23rd March 2019-23rd March 2020, period 2(P2) twelve months of varied restrictions - 24th March 2020-24th March 2021. Data collected from electronic records included age, ethnicity, sex, HIV viral load (VL) (suppression ≤ 200 copies/ml), CD4 count (cells/µL), clinical events, and appointment frequency/modality. Descriptive analysis was comparative between periods. Of 177 YAPaHIV: 56% were female, 86.9% were black, median age at lockdown 23 years (IQR: 21-27). One individual was lost to follow up and excluded from subsequent analysis. 147/176 (83.5%) had a suppressed VL in P1 compared with 156/176 (88.6%) in P2. Of those detectable, median VL was 3200 copies/ml (IQR: 925-36500) in P1, and 911copies/ml (IQR: 317-52300) in P2. In P1, median CD4 was 675 (IQR: 447-845.25). 32(18%) had a CD4 < 350 (median 216.5 [IQR: 94.25-269.75]). 110 (59.5%) had a CD4 count in P2, median 551.5cells/µL (IQR: 329.25-761.25). Thirty one had CD4 < 350 (median 202 [IQR: 134.5-296]). Maintaining face-to-face appointments for vulnerable patients, with remote consultation for stable patients, maintained high levels of care engagement and suppression in a YAPaHIV cohort despite pandemic restrictions.

Novel Adherence Interventions in Perinatally Acquired HIV: PEG Insertion and Pill Glide.

BACKGROUND AND OBJECTIVES: Children, adolescents and young adults (CAYA) with perinatally acquired human immunodeficiency virus (PaHIV) need lifelong antiretroviral therapy (ART) to suppress viral load (VL), maintain health and prevent onward transmission. Many struggle with adherence despite multidisciplinary input. We assessed ART adherence outcomes following two novel interventions: percutaneous endoscopic gastrostomy (PEG) and Pill Glide®, a fruit-flavoured lubricant spray aiding tablet swallowing. METHODS: Retrospective cohort analysis by database and case-note review of PaHIV CAYA aged < 25 years receiving PEG or Pill Glide® between 1995 and 2017 at a single tertiary centre. RESULTS: Nineteen PEGs were inserted in 15 CAYA at a median age of 17 (IQR 6-22) years, median CD4 count 40 cells/µL (IQR 10-220). A viral load (VL) < 50 copies/mL was achieved in 93% with PEG ART. At last follow-up all were alive, median age 23 years (IQR 22-28). Nine had PEG removed, after a median of 3.3 years (range 0.5-6.8), with a current VL < 50 copies/mL, median CD4 count 940 cells/µL (IQR 261-1353) sustained post PEG removal median was 5.4 years (range 1.5-17.8) previously. From 2017 seven CAYA received Pill Glide®, median age 10 years (IQR 7-14), median CD4 count 898 cells/µL (range 148-1943), 6/7 with a suppressed VL. All reported increased ease in tablet swallowing and transitioned successfully from crushed tablets/liquids to tablets. At follow-up, all patients had a suppressed VL. CONCLUSIONS: Whilst PEG insertion markedly improved rates of viral suppression in CAYA struggling with ART adherence, the use of novel less invasive aids such as Pill Glide® requires further exploration.