Characteristics and Care Outcomes Among Persons Living With Perinatally Acquired HIV Infection in the United States, 2015

Kristen Mahle Gray, MPH; Xiao Wang, MPH; Jianmin Li, DPE; Steven R. Nesheim, MD

Disclosures

J Acquir Immune Defic Syndr. 2019;82(1):17-23. 

In This Article

Abstract and Introduction

Abstract

Background: Medical advancements have improved the survival of persons with perinatally acquired HIV infection (PHIV). We describe persons living with diagnosed PHIV and assess receipt of HIV care, retention in care, and viral suppression.

Methods: Data reported to the National HIV Surveillance System through December 2017 were used to characterize persons living with diagnosed PHIV by year-end 2015 in the United States and 6 dependent areas. National HIV Surveillance System data from 40 jurisdictions with complete laboratory reporting were used to assess receipt of HIV care (≥1 CD4 or viral load during 2015), retention in HIV care (≥2 CD4 or viral load tests ≥3 months apart during 2015) and viral suppression (<200 copies/mL during 2015) among persons with PHIV diagnosed by year-end 2014 and alive at year-end 2015.

Results: By year-end 2015, 11,747 persons were living with PHIV and half were aged 18–25 years. Of 9562 persons with HIV diagnosed by year-end 2014 and living with PHIV at year-end 2015 in the 40 jurisdictions, 75.4% received any care, 61.1% were retained in care, and 49.0% achieved viral suppression. Persons aged ≤17 years had a significantly higher prevalence of being retained in care (prevalence ratio = 1.2, 95% confidence interval = 1.2 to 1.3) and virally suppressed (prevalence ratio = 1.4, 95% confidence interval = 1.3 to 1.5) than persons aged 18–25 years.

Conclusions: Efforts to improve care outcomes among persons with PHIV are needed. Enhanced collaboration between pediatric and adult medical providers may ensure continuity of care during the transition from adolescence to adulthood.

Introduction

The HIV care continuum encompasses HIV testing, linkage to care upon diagnosis of HIV infection, retention in care, and achievement of viral suppression.[1] The United States (US) national HIV prevention goals highlight the need for improved outcomes along the HIV care continuum and recognize young persons aged 13–24 years as a population at risk.[2,3] Data collected through the US National HIV Surveillance System (NHSS), maintained by the CDC, are used to monitor outcomes along the HIV care continuum; however, analyses specific to persons living with perinatally acquired HIV infection (PHIV) are limited. The most recent analysis describing the care continuum among persons with diagnosed HIV infection in the United States found that 73.4% of persons received any care, 57.2% were retained in care, and 59.8% achieved viral suppression; however, this report did not include data from persons aged <13 years or for the subset of persons with HIV infection attributed to perinatal transmission.[4]

Advancements in antiretroviral therapy (ART) have dramatically improved the survival of persons living with PHIV.[5–7] Adolescents and young adults living with PHIV are now healthier than earlier birth cohorts, with fewer opportunistic infections and complications of HIV, and better immunologic status.[6,8–12] Despite these successes, a variety of clinical challenges (eg, treatment fatigue and multiple drug resistance)[7,13] and psychosocial challenges (eg, stigma, mental health, substance abuse, lack of health insurance, and transportation)[7,13–15] can contribute to ART adherence issues and threaten sustained viral suppression among youth.

In this analysis, we (1) describe persons living with diagnosed PHIV at year-end 2015 in the United States and 6 dependent areas and (2) analyze receipt of HIV care, retention in HIV care, and viral suppression by selected characteristics among persons with PHIV, diagnosed by year-end 2014 and alive at year-end 2015 from 40 jurisdictions with complete laboratory reporting. To the best of our knowledge, this study represents the first use of national surveillance data to estimate outcomes along the HIV care continuum for persons living with PHIV in the United States.

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