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. 2025 Dec 24;81(5):962-969.
doi: 10.1093/cid/ciaf300.

Incidence of AIDS-Defining Conditions Among Adults With Perinatally Acquired HIV After Transition to Adult HIV Care in the United States and Canada, 2000-2022

Nel Jason L Haw  1 , Catherine R Lesko  1 , Derek K Ng  1 , Jennifer O Lam  2   3 , Kelly Gebo  4 , Timothy R Sterling  5 , Charles S Rabkin  6 , Jun Li  7 , Kate Buchacz  7 , Allison Agwu  4   8 , Keri Althoff  1 ; North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD)
Collaborators, Affiliations

Incidence of AIDS-Defining Conditions Among Adults With Perinatally Acquired HIV After Transition to Adult HIV Care in the United States and Canada, 2000-2022

Nel Jason L Haw et al. Clin Infect Dis. .

Abstract

Background: Little is known about the incidence of AIDS-defining conditions (ADCs) among people with perinatally acquired human immunodeficiency virus (PHIV) who transitioned to adult human immunodeficiency virus (HIV) care in the United States and Canada. We described the incidence among PHIV and compared it with that among those with non-perinatally acquired HIV (non-PHIV) and across calendar era.

Methods: Using data from the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) from 2000-2022, we estimated weighted mean cumulative counts (MCCs) of ADCs, comparing people with PHIV and non-PHIV acquisition risk groups aged 18-40 years engaged in adult HIV care. The weights accounted for differences in characteristics among HIV acquisition risk groups as well as informative censoring. We calculated 95% confidence intervals using bootstrapping. We stratified results before and after 2012, when the immediate start of antiretroviral therapy was first recommended.

Results: There were 5429 ADCs among 22 950 people with HIV. Among those with PHIV, the MCC of ADCs by 3 years in adult HIV care was 26 per 100 persons (95% confidence interval, 15-40) in 2000-2011 and 16 per 100 (5-21) in 2012-2022. Within each calendar era, weighted MCCs of ADCs among people with PHIV were similar or lower than in non-PHIV groups. Within each HIV acquisition risk group, weighted MCCs of ADCs were lower in 2000-2011 than in 2012-2022.

Conclusions: People with PHIV who transitioned to adult HIV care did not experience a greater ADC incidence than those with non-PHIV. This emphasizes the importance of continued engagement in adult HIV care, as it provides critical opportunities for ADC prevention and management.

Keywords: AIDS-defining conditions; HIV; lifetime survivors; perinatally acquired.

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Conflict of interest statement

Potential conflicts of interest. C. R. L., D. K. N., T. R. S., J. L., A. A., and K. A. have received research grants from the NIH to their respective institutions. K. G. has received royalties from UpToDate; has served on a scientific advisory board for Shionogi and Pfizer (noncompensated); has received personal consulting fees from Spark HealthCare, Premier HealthCare, Harrison Consulting, and MedEd Learning; and has served on scientific advisory boards of Shionogi and Pfizer. A. A. has previously served on the scientific advisory boards of Gilead and Merck and as a site investigator under a clinical research contract with Gilead managed through Johns Hopkins University. K. A. has received royalties from Coursera. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
Weighted mean cumulative counts (MCCs) of AIDS-defining conditions, comparing perinatal with other human immunodeficiency virus (HIV) acquisition routes among people with HIV aged 18–40 years in the United States and Canada, 2000–2022. MCC differences and ratios were calculated after 3 years in adult HIV care, with perinatally acquired HIV as the comparison group. Parenthetical ranges for MCC difference and ratios represent 95% confidence intervals, calculated from 1000 nonparametric bootstrap resamples of the data.
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