Although youth living with HIV have fewer opportunistic infections and lower death rates in the era of antiretroviral therapy, an increase in psychiatric, neurodevelopmental, and inflammatory diseases, as well as other health issues need to be addressed, according to a study published in Clinical Infectious Diseases.

Gayatri Mirani, MD of the Tulane University School of Medicine in New Orleans, Louisiana and colleagues examined data on 1201 youth with HIV who were enrolled in the IMPAACT P1074, a multicenter cohort study conducted between 2008-2014. The researchers compared complication and death rates with 2358 youth in the 2004-2007 observational cohort PACTG P219C study.

The most commonly reported comorbidities in this patient population included asthma, pneumonia, psychiatric disorders, neurodevelopmental disorders, and genital tract infections.  


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The researchers noted that although some opportunistic infections that had been associated with past youth HIV infection epidemics have become less common, many remain primary causes of mortality. For example, pneumonia incidence significantly decreased, although the illness is still an issue for HIV infected youth.

Researchers noted increases in sexually transmitted diseases such as chlamydia and human papillomavirus, as well as increases in  substance or alcohol abuse, latent tuberculosis, diabetes mellitus, atypical mycobacterial infections, vitamin D deficiency or metabolic bone disorders, anxiety disorders, and fractures when compared with the earlier data. 

There were 28 deaths during the study, with 86% associated with HIV-related medical conditions. Researchers noted these deaths were in infected youth who were older, likely weren’t receiving cART, had higher viral loads and lower CD4 counts.1

“Adding to challenges facing HIV-infected youth are high rates of psychiatric and neurodevelopmental problems, which not only directly contribute to morbid conditions but also have secondary consequences such as medication nonadherence, risk-taking behavior, and increased HIV transmission,” the researchers wrote in the study.

References

1. Mirani G, Williams PL, Chernoff M et al. Changing trends in complications and mortality rates among US youth and young adults with HIV infection in the era of combination antiretroviral therapy.Clin Infect Dis. 2015 (61). Published December 15, 2015. Accessed December 20, 2015.