Health Issues May Increase as Perinatally HIV-Infected Youth Age

As Americans infected with HIV around the time of their birth continue to age, they have an increased risk of experiencing serious health problems, poor control of the virus, or even death, throughout their adolescence and young adulthood.

For a study published in JAMA Pediatrics, investigators combined data from the Pediatric HIV/AIDS Cohort Study and the International Maternal Pediatric Adolescent AIDS Clinical Trials Network—–2 large, long-term studies conducted in the United States.

The investigators examined the health of more than 1400 perinatally HIV-infected children, adolescents, and young adults aged 7 to 30 years between 2007 and 2015.

The results of the study found that youth aged 13 to 30 years were more likely to have poor HIV control, AIDS-related illnesses, and death compared with young patients. Poor HIV control was defined as higher levels of the virus and lower levels of CD4 immune cells.

Furthermore, poor control of HIV was found 35% of the time among participants aged 18 to 30 years, thus increasing the risk of becoming resistant to certain HIV medications and spreading the virus.

The authors noted that the findings were consistent with other US and European reports, but despite being engaged in health care, the number of deaths among youth born in the United States is 6 to 12 times higher than rates among youth without HIV of the same age, race, and gender.

“Adolescents infected with HIV—–either at birth or later in life––experience poorer health outcomes compared [with] adults with HIV in nearly every respect,” said lead investigator Anne Neilan, MD, MPH. “The good news is that among those with good HIV control, serious health problems are rare.”

The development of antiretroviral therapy (ART) has had a dramatic impact on the HIV/AIDS landscape. In recent decades, fewer than 200 infants per year are born with HIV in the United States due to ART, most whom are over 18 years.

“This is the first generation of perinatally HIV-infected youth living to adulthood, and they are some of the most inspirational, resilient individuals you have ever met,” said co-author George Seage III, DSc.

At the start of AIDS epidemic in the United States during the 1980s, survival rates were grim. But today, treatment developments have virtually changed the face of the disease.

“One of the first reports of AIDS in children was in the early 1980s, by Dr James Oleske of New Jersey Medical School at Rutgers, who is a co-author of our study,” Neilan said. “At that point, getting to the age of 4 was a victory, and living until the third decade of life was unimaginable.”

HIV comes with several health-related problems, with the most commonly reported conditions concerning mental health and brain and nervous system development. Many women in the current study also had sexually transmitted infections, which is associated with lower CD4 immune cell counts.

“This may suggest a biological mechanism for increased STDs or may reflect that patients who have difficulty with their medications are also engaging in more frequent risky sexual behaviors,” said senior author Andrea Ciaranello, MD, MPH.

To improve the health among this population, it’s imperative that these services be strengthened, according to the authors.

“We need to act to strengthen these services for youth, taking into account their developmentally specific needs,” Neilan said. “That might include youth-friendly services that consider the substantial stigma many of these patients face, novel approaches to antiretroviral therapy delivery, and improving support for youth transitioning from pediatric to adult health care providers.”

Ciaranello added, “Understanding how to best care for these youth[s] will not only improve care for youth born with HIV in the US, but will also have implications internationally. For example, HIV is a leading cause of death among African adolescents.”

An improvement in data sharing is another area that can help better treat this patient population.

“A major goal of this study was to make the epidemiologic data available—–in extensive online appendices––to other researchers as a launching point for further research to improve care for these youth,” Seage said. “Long-term follow-up in National Institutes of Health-supported studies like PHACS and IMPAACT P1074 is critical both for determining long-term safety data for antiretroviral drugs, as well as for understanding the health trajectories of these patients.”