28 Mar Adolescents Perinatally Infected with HIV Are At Increased Risk of Serious Physical and Mental Health Problems
MedicalResearch.com Interview with:
Dr. Neilan
Anne M Neilan, MD,MPH
Assistant in Medicine and Pediatrics
Massachusetts General Hospital
Instructor at Harvard Medical School
Department: Medicine Service
Division: Infectious Disease
Department: Pediatric Service
Massachusetts General Hospital
Boston, MA 02114
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Adolescents infected with HIV – either at birth or later in life – experience poorer health outcomes compared to adults with HIV in nearly every respect. This study found that U.S. youth infected with HIV around the time of their birth are at higher risk throughout their adolescence and young adulthood for experiencing serious health problems, poor control of the HIV virus (having high levels of HIV virus in their bodies and fewer CD4 immune cells which protect the body from infection), or death. The study also found that among those with good HIV control, serious health problems are rare.
By combining data from two large, long-term U.S. studies – the Pediatric HIV/AIDS Cohort Study (PHACS, www.phacsstudy.org) and the International Maternal Pediatric Adolescent AIDS Clinical Trials (IMPAACT, www.impaactnetwork.org) Network – we were able to study the health of more than 1,400 perinatally HIV-infected children, adolescents and young adults ages 7 to 30 years between 2007 and 2015. The study found that youth ages 13 to 30 were most likely to have poor HIV control AIDS-related illnesses, and death compared to younger participants. Among 18 – 30 year-olds, the study found that poor control of the HIV virus – meaning higher levels of HIV virus and lower levels of CD4 immune cells which protect the body from infection –35 percent of the time, increasing the risk that these youth would stop responding to certain HIV medications and could transmit HIV to others. These findings are consistent with other U.S. and European reports. Despite being engaged in health care, the number of deaths among youth born with HIV in the U.S. is 6 to12 times higher than for youth without HIV of the same age, sex and race.
Along with HIV-related health problems, the most commonly reported health conditions concerned mental health and brain and nervous system development. Many women in the study also had sexually transmitted infections, which was found to be associated with lower CD4 immune cell counts. This may suggest a biological mechanism or may reflect that patients who have difficulty with their medications are also engaging in more frequent risky sexual behaviors.
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The first reports of HIV/AIDS in children were in the early 1980s, include a seminal paper by by Dr. James Oleske of New Jersey Medical School at Rutgers, who is a co-author of our study. At that point, getting to the age of 4 was a victory, and living until the third decade of life was unimaginable.
This is the first generation of perinatally HIV-infected youth living to adulthood. There now are roughly 10,000 perinatally HIV-infected youth in the U.S., the majority of whom are over age 18. We need to strengthen health services for youth, taking into account their developmentally specific needs. That might include youth-friendly services that consider the substantial stigma many of these patients face, novel approaches to antiretroviral therapy delivery, and improving support for youth transitioning from pediatric to adult health care providers.
Understanding how to best care for these youth will not only improve care for youth born with HIV in the U.S., but will also have implications internationally. For example, HIV is a leading cause of death among African adolescents.
MedicalResearch.com: What should readers take away from your report?
Response: The first reports of HIV/AIDS in children were in the early 1980s, include a seminal paper by by Dr. James Oleske of New Jersey Medical School at Rutgers, who is a co-author of our study. At that point, getting to the age of 4 was a victory, and living until the third decade of life was unimaginable.
This is the first generation of perinatally HIV-infected youth living to adulthood. There now are roughly 10,000 perinatally HIV-infected youth in the U.S., the majority of whom are over age 18. We need to strengthen health services for youth, taking into account their developmentally specific needs. That might include youth-friendly services that consider the substantial stigma many of these patients face, novel approaches to antiretroviral therapy delivery, and improving support for youth transitioning from pediatric to adult health care providers.
Understanding how to best care for these youth will not only improve care for youth born with HIV in the U.S., but will also have implications internationally. For example, HIV is a leading cause of death among African adolescent
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: A major goal of this study was to make the epidemiologic data available – in extensive online appendices – to other researchers as a launching point for further research to improve care for these youth. Long-term follow-up in National Institutes of Health-supported studies like PHACS and IMPAACT P1074 is critical both for determining long-term safety data for antiretroviral drugs, as well as for understanding the health trajectories of these patients.
MedicalResearch.com: Is there anything else you would like to add?
Response: This research was funded by the National Institute of Allergy and Infectious Diseases T32 AI007433, the Eunice Kennedy Shriver National Institute of Child Health and Human Development R01 HD079214 and the Charles Hood Foundation Child Health Research Award. I have no disclosures.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Citation:
Association of Risk of Viremia, Immunosuppression, Serious Clinical Events, and Mortality With Increasing Age in Perinatally Human Immunodeficiency Virus–Infected Youth
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Last Updated on March 28, 2017 by Marie Benz MD FAAD