Differences in clinical characteristics between adolescents and young adults with perinatally and sexually acquired HIV in the Asia‐Pacific region

TL;DR

This study compares health outcomes in young adults with HIV acquired at birth versus through sex in Asia-Pacific, finding similar virus control but growth issues in those with perinatally acquired HIV.

Contribution

The study provides new insights into long-term health differences between adolescents with perinatally and sexually acquired HIV in the Asia-Pacific region.

Findings

Young adults with perinatally acquired HIV had longer ART duration, higher CD4 counts, and more metabolic issues compared to those with sexually acquired HIV.

Viral suppression rates were similar between the two groups at ages 18 and 25.

Living in Thailand and using integrase inhibitor or protease inhibitor regimens were associated with better viral suppression at age 25.

Abstract

We assessed the long‐term HIV‐related health outcomes of young adults with perinatally acquired HIV (PHIV) compared with those who acquired HIV through sexual transmission in the Asia‐Pacific region.

We conducted a cross‐sectional study using data from three paediatric and adult cohorts within the International epidemiology Databases to Evaluate AIDS (IeDEA) Asia‐Pacific consortium. This study included data from 12 countries, collected between 1991 and 2021. Young adults with available data who had been on antiretroviral therapy (ART) for at least 1 year were included. Analyses were conducted at ages 18 and 25 years and compared by route of HIV acquisition. Factors associated with viral suppression (<200 copies/ml) at age 25 were identified using logistic regression.

There were 1333 individuals included at age 18 (96% with PHIV: 46% male) and 305 at age 25 (27% with PHIV; 75% male). Compared to those with sexually acquired HIV at age 18, those with PHIV had a longer median duration of ART (10 vs. 4 years, p<0.001), higher current CD4 count (606 vs. 462 cells/mm3, p = 0.001), were shorter (height 158 vs. 166 cm, p<0.001), with more hypercholesterolemia (20% vs. 5%, p = 0.031) and hypertriglyceridemia (29% vs. 6% mg/dl, p = 0.003). At age 25, differences in duration of ART (15 vs. 3 years, p<0.001), male height (165 vs. 173 cm, p = 0.009) and proportion with hypertriglyceridemia (38% vs. 15%, p = 0.002) were observed. HIV viral suppression did not vary by mode of acquisition (89% vs. 87% at age 18; 91% vs. 85% at age 25). At age 25, living in Thailand (adjusted odds ratio [AOR] 6.05, 95% confidence interval [CI] 1.95−18.80) and use of integrase inhibitor‐based regimens (AOR 5.20, 95% CI 1.62−16.65) or protease inhibitor‐based regimens (AOR 2.62, 95% CI 1.01−6.79) were associated with viral suppression.

Young adults with PHIV who survived to ages 18 and 25 were more likely to have stunted growth but had similar viral suppression to those with sexually acquired HIV in our regional cohorts. However, viral suppression rates remained lower for all relative to the UNAIDS goal of 95%, and measures to improve treatment outcomes are needed for young adults.