Background
People living with perinatally acquired HIV (PPHIV) have unique circumstances: lifelong HIV and its associated inflammation, exposure to multiple suboptimal antiretroviral therapy regimens, HIV acquisition affecting early immune system development, and challenges in transitioning from pediatric to adult HIV care. They have higher rates of non-AIDS defining conditions and may potentially be at higher risk of AIDS-defining conditions (ADCs) than people living with non-perinatal HIV (PnPHIV). As PPHIV progress through adulthood in North America, we described the burden of ADCs for PPHIV compared to those with PnPHIV.
Methods
Using data from the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) from 2000-2022, we estimated mean cumulative counts (MCC) of ADCs comparing PPHIV and PnPHIV aged 18-40 engaged in adult HIV care. ADCs were defined as having a clinical diagnosis of any ADC as reported in the health record, and were allowed to recur more than once during study follow-up. PnPHIV were categorized into three HIV risk groups: male-to-male sexual contact, injection drug use and heterosexual contact. Other HIV risk groups were excluded due to small sample sizes. MCCs of each PnPHIV group were weighted using a propensity score model adjusting for sex at birth, self-identified race, age and calendar year of study entry, and 95% confidence intervals (CI) were calculated using bootstrapping.
Results
Overall, there were 5,715 ADCs among 22,950 people with HIV. There were 109 ADCs among 455 PPHIV. More than half (55%) of PPHIV were female, and 58% were Black. The three most common ADCs among PPHIV were: HIV-associated wasting syndrome (n = 21), esophageal candidiasis (n = 19), and P. jiroveci pneumonia (n = 15). Among PPHIV, the MCC of ADCs by three years in adult HIV care was 27 per 100 persons (95% CI: 14, 42) in 2000-2011 and 18 per 100 persons (95% CI: 9, 28) in 2012-2022. The MCCs of PPHIV were similar to PnPHIV groups during both calendar periods. The MCCs of ADCs decreased between 2000-2011 and 2012-2019 for each HIV risk group. Sensitivity analyses stratified by sex at birth yielded similar results.
Conclusions
PPHIV who have successfully transitioned to adult HIV care have similar experience of ADC burden than their peers with non-perinatal HIV, and do not need any additional ADC prevention or management beyond what all people with HIV should receive. We also emphasize the importance of retention in HIV care as it provides opportunities for ADC prevention.
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