Changes in advanced immunosuppression and detectable HIV viremia among perinatally HIV-infected youth in the multisite united states HIV research network

Background. Due to successful antiretroviral therapy (ART), perinatally human immunodeficiency virus (PHIV)-infected children are reaching adolescence and young adulthood. Adolescence is characterized by factors (eg, increased risk-taking) that may hamper management. We examined PHIV-infected youth in a multisite US cohort, assessing factors associated with changes in advanced immunosuppression and detectable viremia over time. Methods. We conducted a retrospective study of 521 PHIV-infected youth, 12 years and older, followed at 16 HIV clinics in the HIV Research Network between 2002 and 2010. We assessed demographic and clinical factors associated with CD4 <200 cells/mm³ and viral load ≥2.60 log₁₀ HIV-1 RNA copies/mL using multivariable logistic regression. Results. Between 2002 and 2010, the median age of PHIV-infected youth in care increased from 14 to 18 years. The proportion prescribed ART increased from 67.4% to 84%, with virologic suppression increasing from 35.5% to 63.0% (P trend < .01). Older age, Black and Hispanic race/ethnicity, and increasing viremia were independently associated with CD4 <200 cells/mm³. Older age, Black race and Hispanic ethnicity were independently associated with higher likelihood of detectable viremia, whereas more recent year of evaluation and being prescribed ART were associated with a lower likelihood. Conclusions. The proportion of PHIV-infected youth on ART has increased. Rates of viremia and advanced immunosuppression have decreased in recent years, but both rates are higher for older PHIVinfected youth. Factors associated with advanced immunosuppression and viremia offer the chance to define strategies to optimize outcomes.