Virologic Failure in Younger Adulthood More Likely in Perinatally-Acquired HIV

There was a greater decreased risk for virologic failure over time among younger adults with perinatally-acquired HIV compared with those with nonperinatally-acquired HIV.

Results of a study published in Open Forum Infectious Diseases found that younger adulthood is a vulnerable time period for virologic failure among individuals with HIV infection, particularly those with perinatally-acquired infection.

Data for this study were sourced from the Stichting HIV Monitoring (SHM) database, which collects data from 24 sites in the Netherlands. Patients (N=1331) with HIV infection who received care between 2000 and 2020 as younger adults were evaluated for markers of virologic failure. Virologic failure was defined as an HIV viral load of either more than 200 copies/mL or above the lower limit of detection after at least 6 months of antiretroviral therapy (ART). The researchers used a generalized linear mixed model to evaluate longitudinal virologic outcomes and to identify risk factors for virologic failure between patients with perinatally-acquired and nonperinatally-acquired HIV infection.

Among patients included in the analysis, 63.3% were men, the median age at HIV diagnosis was 20.4 (IQR, 18-22) years, the median age at ART initiation was 21.3 (IQR, 18.9-22.7) years of age, and HIV was transmitted via homosexual sex for 43.5% of patients, heterosexual sex for 37.9%, and perinatally for 11.8%.

Stratified by transmission route, patients with perinatally-acquired vs nonperinatally-acquired HIV infection had a higher rate of virologic failure (54.8% vs 42.2%), longer durations of detectable viral loads (mean, 1.8 vs 0.9 years), and higher rates of death prior to 30 years of age (2.5% vs 1.4%).

Among the subset of patients with perinatally-acquired HIV infection, an increased virologic failure risk was associated with receipt of care between 2000 and 2004 vs 2015 and 2020 (odds ratio [OR], 5.34; P <.001), pretreatment with mono or dual therapy (OR, 4.25; P =.003), and being aged between 18 and 24 years vs 25 and 30 years (OR, 2.34; P <.001). In addition, virologic failure was less likely among patients with CD4+ T-cell counts between  200 and 500×106/L (OR, 0.27; P =.003) or more than 500×106/L (OR, 0.08; P <.001) compared with those with counts less than 200×106/L.

For patients with behaviorally-acquired HIV infection, the risk for virologic failure was increased among both heterosexual women (OR, 7.50; P <.001) and heterosexual men (OR, 2.59; P =.003) when compared with men who have sex with men. Further analysis of these patients showed an increased virologic failure risk among those born in Latin America or the Caribbean (OR, 3.26; P <.001) or an undefined location (OR, 2.07; P =.03) compared with those born in the Netherlands. Virologic failure also was more likely among patients who received care between 2000 and 2004 (OR, 12.69; P <.001), 2005 and 2009 (OR, 7.44; P <.001), and 2010 and 2014 (OR, 3.25; P <.001) compared with those who received care between 2015 and 2020; and among those aged between 18 and 24 (OR, 1.26; P =.008) vs 25 and 30 years.

Interventions to support adherence in young adults should consider the possible specific developmental and psychosocial problems that drive non-adherence, as those might differ between risk groups.

In a sensitivity analysis that defined virologic failure as its occurrence on 2 consecutive measurements, similar results were observed.

This study may have been limited as virologic suppression rates tended to be worse among non-White patients.

In regard to patients receiving ART, “Interventions to support adherence in young adults should consider the possible specific developmental and psychosocial problems that drive non-adherence, as those might differ between risk groups,” the researchers concluded.

Disclosure: Multiple authors declared affiliations with industry. Please see the original reference for a full list of disclosures.

References:

Weijsenfeld AM, Smit C, Wit FWNM, et al; on behalf of the ATHENA national observational HIV cohort. Long-term virological treatment outcomes in adolescents and young adults with perinatally and non-perinatally acquired human immunodeficiency virus. Open Forum Infect Dis. 2022;9(11)ofac561. doi:10.1093/ofid/ofac561