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Multicenter Study
. 2015 Dec 15;61(12):1850-61.
doi: 10.1093/cid/civ687. Epub 2015 Aug 12.

Changing Trends in Complications and Mortality Rates Among US Youth and Young Adults With HIV Infection in the Era of Combination Antiretroviral Therapy

Gayatri Mirani  1 , Paige L Williams  2 , Miriam Chernoff  3 , Mark J Abzug  4 , Myron J Levin  4 , George R Seage 3rd  5 , James M Oleske  6 , Murli U Purswani  7 , Rohan Hazra  8 , Shirley Traite  3 , Bonnie Zimmer  9 , Russell B Van Dyke  1 ; IMPAACT P1074 Study Team
Collaborators, Affiliations
Multicenter Study

Changing Trends in Complications and Mortality Rates Among US Youth and Young Adults With HIV Infection in the Era of Combination Antiretroviral Therapy

Gayatri Mirani et al. Clin Infect Dis. .

Abstract

Background: Combination antiretroviral therapy (cART) has resulted in a dramatic decrease in human immunodeficiency virus (HIV)-related opportunistic infections and deaths in US youth, but both continue to occur.

Methods: We estimated the incidence of complications and deaths in IMPAACT P1074, a long-term US-based prospective multicenter cohort study conducted from April 2008 to June 2014. Incidence rates of selected diagnoses and trends over time were compared with those from a previous observational cohort study, P219C (2004-2007). Causes of death and relevant demographic and clinical features were reviewed.

Results: Among 1201 HIV-infected youth in P1074 (87% perinatally infected; mean [standard deviation] age at last chart review, 20.9 [5.4] years), psychiatric and neurodevelopmental disorders, asthma, pneumonia, and genital tract infections were among the most common comorbid conditions. Compared with findings in P219C, conditions with significantly increased incidence included substance or alcohol abuse, latent tuberculosis, diabetes mellitus, atypical mycobacterial infections, vitamin D deficiency or metabolic bone disorders, anxiety disorders, and fractures; the incidence of pneumonia decreased significantly. Twenty-eight deaths occurred, yielding a standardized mortality rate 31.5 times that of the US population. Those who died were older, less likely to be receiving cART, and had lower CD4 cell counts and higher viral loads. Most deaths (86%) were due to HIV-related medical conditions.

Conclusions: Opportunistic infections and deaths are less common among HIV-infected youth in the US in the cART era, but the mortality rate remains elevated. Deaths were associated with poor HIV control and older age. Emerging complications, such as psychiatric, inflammatory, metabolic, and genital tract diseases, need to be addressed.

Keywords: mortality; opportunistic infections; pediatric HIV; pregnancy; psychiatric.

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Figures

Figure 1.
Figure 1.
Significant temporal trends in diagnoses and pregnancy among P1074 participants between 2008 and 2014. Trends are based on Poisson regression models with number of events in a given year as the outcome, calendar year as a linear predictor, and offset term equal to log person-years of follow-up during that calendar year. Abbreviation: SE, standard error.
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References

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