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Youth infected with HIV more susceptible to adverse outcomes in adolescence, young adulthood
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Youth who were infected with HIV perinatally who do not strictly adhere to ART as adolescents and young adults were at higher risk of viremia, immunosuppression, CDC-B and CDC-C events and mortality, according to a recent study.
“Rates of viremia and immunosuppression have decreased among [perinatally HIV–infected youth (PHIVY)] in the United States since the implementation of effective combination antiretroviral therapy — cART — but may remain higher for older PHIVY,” Anne M. Neilan, MD, MPH, from the Division of Infectious Diseases and the Medical Practice Evaluation Center at Massachusetts General Hospital, and colleagues wrote. “Compared with adults, PHIVY experience lower rates of HIV RNA viral load suppression and higher rates of loss to follow-up. As youth age and transition to adult care, their risks of opportunistic infections, other serious clinical events, and mortality are not well described.”
The researchers observed the timing of key clinical events at follow-up, including CDC stage B and stage C events and mortality, for PHIVY. The 1,446 youth who participated in this study were categorized into groups by age cohort (7-12 years, 13-17 years and 18-30 years), CD4 cell count (less than 200, 200-499 and greater than or equal to 500), and viral load and ART status (VL less than 400 or greater than or equal to 400 copies/mL, ART or no ART).
Data on patients was collected from the Pediatric HIV/AIDS Cohort Study (PHACS) Adolescent Master Protocol and International Maternal Pediatric Adolescent AIDS Clinical Trials (IMPAACT)P1074 multicenter cohort studies that occurred between March 2007 and April 2015. The event rates were estimated within each stratum.
As age increased in participants, the incidence of CDC-B or CDC-C events and mortality rose at mean follow-ups (4.9 years). For those aged between 13and17 and 18 and 30, more time was spent with a viral load greater than or equal to 400 copies/mL with a CD4 cell count less than 200/µL. PHIVY experienced a mortality rate six to 12 times higher than that of the general population, and, after adjusting for age, sexually transmitted infections were noticed when CD4 cell counts were lower.
“We need to act to strengthen these services for youth, taking into account their developmentally specific needs,” Neilan said in a press release. “That might include youth-friendly services that consider the substantial stigma many of these patients face, novel approaches to [ART] and improving support for youth transitioning from pediatric to adult health care providers.” — by Katherine Bortz
Disclosure: The researchers report no relevant financial disclosures or conflicts of interest.
Perspective
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Aditya Gaur, MD
On the one hand, it is heartening to note the oldest cohort reported by Neilan and colleagues is 26 to 30 years of age and underscores that the goal of HIV management has long moved from short-term survival to long-term health. At the same time, the researchers alert health care providers, researchers and policy makers about the increased rates of morbidity and mortality in this population of aging of youth who have lived with HIV infection all their lives compared with those of their younger HIV– infected peers, as well as the general U.S. population.
The noted longer time spent with HIV viremia and relative immunosuppression compared with their younger counterparts is concerning from the standpoint of long-term prognosis for this cohort of youth. This emphasizes the need for models of care that can support these youth as they transition from adolescence into adulthood, optimizing adherence to appointments and medications and at the same time promoting a healthy lifestyle and harm reduction.
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