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. 2025 Oct 10;12(11):ofaf624.
doi: 10.1093/ofid/ofaf624. eCollection 2025 Nov.

Long-Term Outcomes of Young Adults With Perinatal Human Immunodeficiency Virus (HIV) Infection in the United States and Puerto Rico

Leah Kern  1 , Alicia Jaramillo-Underwood  2   3 , Kunjal Patel  2   3 , Sean S Brummel  3 , Renee A Smith  4 , Stephen A Spector  1 ; Pediatric HIV/AIDS Cohort Study
Collaborators, Affiliations

Long-Term Outcomes of Young Adults With Perinatal Human Immunodeficiency Virus (HIV) Infection in the United States and Puerto Rico

Leah Kern et al. Open Forum Infect Dis. .

Abstract

Background: Data on mortality, clinical events, viral load (VL), and immunosuppression among young adults aging with perinatally acquired human immunodeficiency virus (YAPHIV) are limited.

Methods: Among YAPHIV ≥ 18 years in the Pediatric HIV/AIDS Cohort Study, we calculated incident mortality, CDC-C/WHO-4 rates, and proportion of person-years (PY) with elevated VL (≥200 copies/mL) and immunosuppression (CD4 < 200 cells/mm3) by age strata 18-21, 22-25, 26-29, and ≥30 years. We compared mortality rates to the US population and identified predictors of mortality/CDC-C/WHO-4 events at age ≥ 25 years.

Results: Six hundred seventeen participants had median follow-up of 6.5 years; at baseline, 63% were 18-21 years, 61% were female, 63% self-reported as Black, median CD4 count was 561 cells/mm3, and 66% had VL < 200 copies/mL. Mortality was highest at ≥30 years (8.1 per 1000PY [95% CI: 3.0, 22.0]). Black YAPHIV had mortality rates at least 7.1 (3.0, 17.1) times higher than white non-Hispanic persons in the US population. Proportion of elevated VL person-time decreased while low CD4 person-time increased as participants aged. Among 307 participants followed after age ≥ 25 years, elevated VL, low CD4, and prior CDC-C/WHO-4 event strongly predicted risk of incident mortality/CDC-C/WHO-4 event (C-index: 0.94); risk at 3 years of follow-up was 19% (0%, 45%) among those with all 3 characteristics. Other important predictors were poor treatment adherence, current cannabis use, lack of current employment/education, and stressful events (C-index: 0.81).

Conclusions: There is excess mortality with age for YAPHIV, particularly for Black YAPHIV. Interdisciplinary interventions are needed to improve treatment outcomes for YAPHIV at highest identified risk.

Keywords: clinical events; mortality; perinatal HIV; young adults.

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Conflict of interest statement

Potential conflicts of interest. All authors: No reported 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.

References

    1. Brady MT, Oleske JM, Williams PL, et al. Declines in mortality rates and changes in causes of death among HIV-1-infected children during the HAART era. J AIDS 2010; 53:86–94. - PMC - PubMed
    1. Mirani G, Williams PL. Changing trends in complications and mortality rates among US youth and young adults with HIV infection in the era of combination antiretroviral therapy. Clin Inf Dis 2015; 61:1850–61. - PMC - PubMed
    1. Joint Programme on HIV/AIDS (UNAIDS) . Young people and HIV. UNAIDS 2021. Accessed from Available at: https://www.unaids.org/sites/default/files/media_asset/young-people-and-... on 5 March 2022.
    1. Harza R, Siberry GK, Mofenson LM. Growing up with HIV: children, adolescents, and young adults with perinatally acquired HIV infection. Annu Rev Med 2010; 61:169–85. - PubMed
    1. Sohn AH, Harza R. The changing epidemiology of the global paediatric HIV epidemic: keeping track of perinatally HIV-infected adolescents. J Int AIDS 2013; 16:18555. - PMC - PubMed