Perinatal HIV Adolescents and young adults in transition to adulthood

Background: The introduction of combination antiretroviral therapy (ART) in 1996 has globally led to decreasing numbers of new (perinatally acquired) HIV infections and reduced AIDS-related deaths. Nevertheless, controlling the epidemic remains challenging as people living with HIV are dependent on continuous ART. Young adults (YA) living with HIV face particular challenges maintaining viral suppression. This thesis examined virological outcomes, experiences with transition to adult care and health-related quality of life (HRQoL) in YA with perinatally acquired HIV 
(PHIV), and compared virological outcomes with peers with non-perinatally acquired HIV 
(NPHIV). 
Methods: A mixed-methods approach was used, combining national cohort data, medical record data from Dutch paediatric and adult HIV centres, questionnaire data, and semi-structured interviews. Associations between clinical and demographic factors and outcomes were assessed in both PHIV and NPHIV groups. 
Results: Despite effective ART, YA with PHIV still have lower viral suppression rates than those with NPHIV and the broader HIV population in the Netherlands. Key challenges during and after transition to adult care involve engagement in care, self-management, health literacy, and relationships with healthcare providers. HRQoL is impacted by stigma and disclosure issues, parental dynamics, and challenges related to education and employment. 
Conclusion: The challenges faced by these YA likely stem from the intersection of adolescent development, lifelong HIV infection, exposure to earlier and less effective ART regimens and psychosocial factors. Beyond the use of existing transition programs, additional YA tailored structural interventions may improve outcomes for those moving into adult care and adulthood.