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Journal article
Long-term outcomes of young adults with perinatal HIV infection in the U.S. and Puerto Rico
Open forum infectious diseases, v 12(11), ofaf624
10 Oct 2025
PMID: 41244598
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Background
Data on mortality, clinical events, viral load (VL), and immunosuppression among young adults aging with perinatally-acquired HIV (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
617 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 three 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.
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Details
- Title
- Long-term outcomes of young adults with perinatal HIV infection in the U.S. and Puerto Rico
- Creators
- Leah Kern (Corresponding Author) - University of California San DiegoAlicia Jaramillo-Underwood - Harvard UniversityKunjal Patel - Harvard UniversitySean S Brummel - Cancer Research And BiostatisticsRenee Smith - Comer Children's HospitalStephen A Spector - University of California San DiegoEllen ChadwickEmanuela (Lela) LarteyRohit KalraKathleen Malee - Institute of Behavioral SciencesMary Paul - Baylor College of MedicineShelley BuschurChivon McMullen-Jackson - College Station Medical CenterLynnette HarrisMurli Purswani - Bronx-Lebanon Hospital CenterMartha CavalloMahboobullah Mirza Baig - Bronx-Lebanon Hospital CenterAlma Villegas - Bronx-Lebanon Hospital CenterLisa- Gaye RobinsonPatricia Garvie - Children's Diagnostic & Treatment CenterAlan BerneggerSandra K BurchettMichelle E AndersonChristine M SaloisAndrew Wiznia - College Station Medical CenterMarlene Burey - College Station Medical CenterRay ShawArry DieudonneJuliette JohnsonKaren SurowiecJanet S Chen - Drexel University, PediatricsTaesha White - Drexel University, PediatricsMitzie Grant - Drexel University, PsychiatryKatherine KnappErick OderoMegan WilkinsNicolas RosarioHeida RiosVivian OliveraMargarita Silio - Tulane UniversityMedea GabrielPatricia Sirois - Tulane UniversityMegan LoughranVeronica FigueroaSharon Nichols - Drexel University, Nursing (Undergraduate)Elizabeth McFarland - University of Colorado DenverCarrie Chambers - University of Colorado DenverChristine KwonRobin McEnvoyGwendolyn Scott - University of MiamiGrace Alvarez - University of MiamiJuan Caffroni - University of MiamiAnai Cuadra - University of Miamifor the Pediatric HIV/AIDS Cohort Study
- Publication Details
- Open forum infectious diseases, v 12(11), ofaf624
- Publisher
- Oxford University Press
- Number of pages
- 7
- Grant note
- Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)Office of The Director, National Institutes of Health (OD)National Institute of Dental and Craniofacial Research (NIDCR)National Institute of Allergy and Infectious Diseases (NIAID)National Institute of Neurological Disorders and Stroke (NINDS)National Institute on Deafness and Other Communication Disorders (NIDCD)National Institute of Mental Health (NIMH)National Institute on Drug Abuse (NIDA)National Cancer Institute (NCI)National Institute on Alcohol Abuse and Alcoholism (NIAAA)National Heart, Lung, and Blood Institute (NHLBI): P01HD103133, HD052102, HD052104
The Pediatric HIV/AIDS Cohort Study (PHACS) network was supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD), Office of The Director, National Institutes of Health (OD), National Institute of Dental and Craniofacial Research (NIDCR), National Institute of Allergy and Infectious Diseases (NIAID), National Institute of Neurological Disorders and Stroke (NINDS), National Institute on Deafness and Other Communication Disorders (NIDCD), National Institute of Mental Health (NIMH), National Institute on Drug Abuse (NIDA), National Cancer Institute (NCI), National Institute on Alcohol Abuse and Alcoholism (NIAAA), and National Heart, Lung, and Blood Institute (NHLBI) through grants to the Harvard T.H. Chan School of Public Health (P01HD103133 and HD052102) and with Tulane University School of Medicine (HD052104).
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Nursing (Undergraduate); Pediatrics
- Web of Science ID
- WOS:001616043100001
- Other Identifier
- 991022123313904721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Immunology
- Infectious Diseases
- Microbiology