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Changes in Advanced Immunosuppression and Detectable HIV Viremia Among Perinatally HIV-Infected Youth in the Multisite United States HIV Research Network

Changes in Advanced Immunosuppression and Detectable HIV Viremia Among Perinatally HIV-Infected Youth in the Multisite United States HIV Research Network

Journal of the Pediatric Infectious Diseases Society 2(3): 215-223

Due to successful antiretroviral therapy (ART), perinatally human immunodeficiency virus (PHIV)–infected children are reaching adolescence and young adulthood. Adolescence is characterized by factors (eg, increased risk-taking) that may hamper management. We examined PHIV-infected youth in a multisite US cohort, assessing factors associated with changes in advanced immunosuppression and detectable viremia over time. We conducted a retrospective study of 521 PHIV-infected youth, 12 years and older, followed at 16 HIV clinics in the HIV Research Network between 2002 and 2010. We assessed demographic and clinical factors associated with CD4 <200 cells/mm3 and viral load ≥2.60 log10 HIV-1 RNA copies/mL using multivariable logistic regression. Between 2002 and 2010, the median age of PHIV-infected youth in care increased from 14 to 18 years. The proportion prescribed ART increased from 67.4% to 84%, with virologic suppression increasing from 35.5% to 63.0% (P trend < .01). Older age, Black and Hispanic race/ethnicity, and increasing viremia were independently associated with CD4 <200 cells/mm3. Older age, Black race and Hispanic ethnicity were independently associated with higher likelihood of detectable viremia, whereas more recent year of evaluation and being prescribed ART were associated with a lower likelihood. The proportion of PHIV-infected youth on ART has increased. Rates of viremia and advanced immunosuppression have decreased in recent years, but both rates are higher for older PHIV-infected youth. Factors associated with advanced immunosuppression and viremia offer the chance to define strategies to optimize outcomes.

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Accession: 036803362

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PMID: 26619475

DOI: 10.1093/jpids/pit008

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