Summary data to the end of March 2018
A total of 2,151 children were reported to CHIPS by the end of March 2018, comprising virtually all of those receiving HIV-related care in the UK and Ireland from 2006 onwards. Overall, 42% were born in the UK or Ireland, 56% were born abroad and 2% unknown. For those born in the UK or Ireland, the median age at first presentation has been relatively constant at around 6 to 18 months although 17% did not present until ≥5 years of age. For children born abroad, the median age at first presentation ranged from 9 to 12 years among those first presenting to care between 2009 and 2017. In the last five years (2014-2018) around 25-60 newly diagnosed children have been reported each year.
By the end of March 2018, 116 (5.4%) children were known to have died while receiving paediatric care, and of these deaths, 96 occurred prior to 2008, nine were in 2008, six in 2009, one in 2010, two in 2011 and one in 2016. Overall, 122 (5.7%) children were reported to have left the country and 38 (1.8%) were lost to follow up. To date 1074 (50%) young people have left paediatric HIV care and transitioned to adult clinics, with 50-120 patients transferring each year between 2009 and 2017. The median age at transfer has been relatively steady at around 18 years. A total of 801 patients were alive and in active follow-up at a paediatric clinic. Of these, just over half (54%) were female, 48% were born in the UK or Ireland, 77% were of black ethnicity, and the vast majority (91%) were known to have been infected through mother-to-child transmission. Forty-five per cent of children were being seen at clinics in London, 42% in the rest of England, 3% in Scotland, 2% in Wales, 1% in Northern Ireland and 6% in the Republic of Ireland. The median age at last visit was 14.9 years (IQR, 11.6, 16.9).
The overall rate of hospital admissions in the cohort has continued to decline from 69 per 100 child years in 2000 to 7.5 in 2016 and has risen slightly to 9.6 in 2017 (data for 2017 subject to reporting delay and may not be complete). Viral load suppression among those starting combination ART naïve has improved with calendar time: 42% suppressed viral load ≤50c/ml at 12 months after start of ART in 2000-2004, increasing to 74% in 2010-2014 and 76% for 2015 onwards. Less than one-quarter (22%) of patients had ever progressed to CDC stage C and another quarter (23%) to CDC stage B while in paediatric care. Among patients with a follow up visit since January 2016 (n=764), 31 children (4%) were ART naïve, the majority of whom (n=24, 77%) were aged ≥10 years at time of last visit. Among those on ART at last visit (n=713), 5% of patients were on mono or dual therapy, 90% were on a 3-drug combination antiretroviral regimen (excluding ritonavir booster) and 5% were on regimens including ≥4 drugs.
As part of our outcome measures reported to NHS England, and based on data for 2015 (more recent data are likely to be incomplete due to the time lag in reporting to CHIPS), we observed the following outcomes across all children in the UK/Ireland:
- Retention in care: 28 of the 30 (93%) children newly diagnosed with HIV in 2015 had≥ 2 CD4 and ≥2 VL measurements within 12 months of diagnosis
- Retention on ART: 100% of the 28 children newly starting ART in 2014 remained on ART 12 months later
- Immunological status: Among children aged<5 years, 100% (n=23/23) of those on ART and 10% (n=1/10) of those not on ART had ≥1 CD4% ≥25% in 2015. Among children aged ≥5 years, 95% (n=566/598) of those on ART and 71% (n=61/86) of those not on ART had ≥1 CD4 ≥350 cells/mm3
- Viral suppression on ART: Among patients on ART through 2015 (n=675), the proportion with confirmed virological suppression <400 copies/mL was 87%, and <50 copies/mL was 78%.