Youth With HIV Less Likely to Achieve Viral Suppression

By Anne Harding

February 12, 2020

NEW YORK (Reuters Health) - About one in three U.S. youth diagnosed with HIV will start antiretroviral therapy (ART), while just fewer than one in eight achieve viral suppression, according to new findings.

"The findings underscore the need to engage youth with newly diagnosed HIV promptly from the first point of contact and to maintain frequent contact from the outset in ways that appeal to youth like text messaging, social media and trained peers," Dr. Bill G. Kapogiannis of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) in Bethesda, Maryland, told Reuters Health by email.

Adolescents and young adults account for 21% of those newly diagnosed with HIV, while almost half of young people with HIV don't know they are infected, Dr. Kapogiannis and his colleagues note in the Journal of Acquired Immune Deficiency Syndromes.

While the HIV care continuum (HCC) is well studied in adults, they note, "little research has addressed the continuum among vulnerable populations of HIV-infected U.S. youth who face enormous psychosocial challenges, disparities and health inequities."

The authors looked at the Strategic Multisite Initiative for the Identification, Linkage and Engagement in Care of Youth with Undiagnosed HIV Infection (SMILE), a collaboration involving the NICHD, the Centers for Disease Control and Prevention (CDC), the Health Resources and Services Administration (HRSA), and the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN).

SMILE provided a linkage to care (LTC) coordinator at 13 ATN sites. Coordinators had experience caring for adolescents, and helped newly diagnosed youth transition to clinical care services.

There were 1,411 HIV-infected youth aged 12 to 24 from 13 centers diagnosed during the SMILE initiative. Eighty percent were male, 72% were non-Hispanic black, and 64% reported being gay, bisexual or questioning.

Nearly two-thirds of study participants had advanced HIV (viremia above 10,000 copies/mL, CD4 T cell count below 350 cells/uL). The viral load was higher for males than for females or transgender youth.

Three-quarters were LTC, 59% engaged with care, and 34% were retained in care. Thirty-four percent started ART and 12% achieved viral suppression, during a median follow-up of 4.8 months.

LTC failed due to lack of contact information or inability to find a study participant, study participant refusal, repeated missed appointments, or living outside the study area.

Viral suppression occurred significantly more often in patients who recently started ART (hazard ratio, 2.54), had a lower viral load at LTC (HR, 1.33) and had access to case management from non-ATN staff (HR, 1.67), while it was significantly less frequent in study participants with recent substance use (HR, 0.68).

Young people who were referred to care within three months of testing were more than twice as likely to reach viral suppression than those who were referred later.

"While our findings suggest youth-friendly coordinators may facilitate better linkage to care from testing sites, our findings also highlight significant gaps in achieving durable viral suppression that require further studies on how to best tailor HIV intervention services to the needs of youth," Dr. Kapogiannis said.

The study did not have commercial funding. The authors report no conflicts of interest.

SOURCE: Journal of Acquired Immune Deficiency Syndromes, online January 28, 2020.