A New Study Details Health Outcomes in Aging Perinatally HIV-Infected

The mortality rate for older perinatally human immunodeficiency virus-infected youth (PHIVY) from 13 to 30 year of age is 6 to 12 times higher than in the general US population, according to a recent study.

Through their study, the researchers sought to provide clinicians with information on the effects of age, CD4 cell count, viral load (VL), and antiretroviral (ARV) drug use among PHIVY who are growing older and more treatment experienced.
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The researchers included 1446 PHIVY, aged 7 to 30 years, who were involved in either the Pediatric HIV/AIDS Cohort Study or the International Maternal Pediatric Adolescent AIDS Clinical Trials P1074 in their study; 759 of the participants were female (52.5%) and 953 of the participants were black (65.9%). Researchers followed participants for 4.9 (1.3) years.

Incidences or first occurrence of key clinical events, including Centers for Disease Control and Prevention stage B (CDC-B) and stage C (CDC-C) events, and mortality, were estimated and stratified by person-time in age, CD4 cell count, and a combined measure of VL and ARV status. 

As participants aged, higher incidences of CDC-B events, CDC-C events, and mortality were observed. PHIVY aged 13 to 17 years and PHIVY aged 18 to 30 years showed longer time with a VL of 400 copies/mL or more and with a CD4 cell count less than 200/µL compared with PHIVY aged 7 to 12 years (30% and 44% vs 22% of person-time with a VL≥400 copies/mL; 5% and 18% vs 2% of person-time with CD4 cell count <200/µL; P < .001 for each comparison).

In addition, researchers observed higher rates of CDC-B events, CDC-C events, bacterial infections, and mortality in participants with lower CD4 cell counts, as well as higher rates of sexually transmitted infections after adjusting for age.

“Older PHIVY were at increased risk of viremia, immunosuppression, CDC-B events, CDC-C events, and mortality. Interventions to improve ARV therapy adherence and optimize models of care for PHIVY as they age are urgently needed to improve long-term outcomes among PHIVY,” the researchers concluded.

—Melissa Weiss

Reference:

Neilan AM, Karalius B, Patel K, et al. Association of risk of viremia, immunosuppression, serious clinical events, and morality with increasing age in perinatally human immunodeficiency virus-infected youths [published online March 27, 2017]. JAMA Pediatr. doi:10.1001/jamapediatrics.2017.0141.