There is a demographic gap between babies born with HIV in the past and recently. Older patients are at an increased risk for viral load in blood, immunosuppression, more severe clinical events, and mortality compared to those born recently due to advances in treatments starting at an earlier age.
Current antiretroviral (ARV) and combination antiretroviral therapy (cART) have allowed HIV-positive patients to live much longer and also enjoy a higher quality of life. Also, the use of these therapies has reduced mother-to-child transmission and also created a new demographic of young people on treatment from an early age. These perinatally HIV-infected youth (PHIVY) can be separated into two broad age groups: 7-12 and 13-30. Patients were included in the study if they had 1 or more visits to the hospital, 1 or more white blood cell counts or viral load measures after the initial measurement.
The authors of the study wanted to gain a better understand the association of age, white blood cell count, viral load, and ARV drug use with severe clinical events and mortality as PHIVY grow older. The researchers analyzed data from participants in the Pediatric HIV/AIDS Cohort Study (PHACS) Adolescent Master Protocol (AMP) and the International Maternal Pediatric Adolescent AIDS Clinical Trials (IMPAACT), totaling 1,446 people between 7 to 30 years of age. The participants were characterized by those who received a combination of ARV, white blood cell count, and viral load on follow-up visits to the hospital.
The clinical event rates could be separated into age groups, white blood cell count, and the amount of viral load and therapy status. The clinical events were further separated according to severity: Centers for Disease Control and Prevention Stage B or C (CDC-B or CDC-C).
It was found that older PHIVY (18-30 years old) were at a higher risk for blood viral load, low white blood cell counts, more serious clinical events, and CDC-B and CDC-C events. Higher blood viral load could be due to not following medication instructions correctly or accumulated viral load over time. The advent of combination antiretroviral therapy occurred when PHIVY were older and have had less time on the therapy. Older PHIVY also spent more time with lower white blood cell counts (under 200/µl). Secondly, it was found that use of cART resulted in fewer clinical events and deaths.
In conclusion, the authors found ART to have a strong suppressive effect on serious clinical events, opportunistic infections, and death; however, viral blood load, lower white blood cell counts, and rates of clinical events and death increased throughout adolescence and young adulthood. These results indicate a need to improve adherence to antiretroviral therapy for PHIVY beginning during adolescence and through adulthood to improve long-term outcomes.
Limitations of the study: years 7 – 12 were less represented compared to other groups and there were two different data collection protocols which may have affected rate estimates.
Written By: Kenneth Dominguez, PhD