Changing Trends in Complications and Mortality Rates Among US Youth and Young Adults With HIV Infection in the Era of Combination Antiretroviral Therapy.
BACKGROUND
Combination antiretroviral therapy (cART) has resulted in a dramatic decrease in human immunodeficiency virus (HIV)-related opportunistic infections and deaths in US youth, but both continue to occur.


METHODS
We estimated the incidence of complications and deaths in IMPAACT P1074, a long-term US-based prospective multicenter cohort study conducted from April 2008 to June 2014. Incidence rates of selected diagnoses and trends over time were compared with those from a previous observational cohort study, P219C (2004-2007). Causes of death and relevant demographic and clinical features were reviewed.


RESULTS
Among 1201 HIV-infected youth in P1074 (87% perinatally infected; mean [standard deviation] age at last chart review, 20.9 [5.4] years), psychiatric and neurodevelopmental disorders, asthma, pneumonia, and genital tract infections were among the most common comorbid conditions. Compared with findings in P219C, conditions with significantly increased incidence included substance or alcohol abuse, latent tuberculosis, diabetes mellitus, atypical mycobacterial infections, vitamin D deficiency or metabolic bone disorders, anxiety disorders, and fractures; the incidence of pneumonia decreased significantly. Twenty-eight deaths occurred, yielding a standardized mortality rate 31.5 times that of the US population. Those who died were older, less likely to be receiving cART, and had lower CD4 cell counts and higher viral loads. Most deaths (86%) were due to HIV-related medical conditions.


CONCLUSIONS
Opportunistic infections and deaths are less common among HIV-infected youth in the US in the cART era, but the mortality rate remains elevated. Deaths were associated with poor HIV control and older age. Emerging complications, such as psychiatric, inflammatory, metabolic, and genital tract diseases, need to be addressed.
Tulane University School of Medicine, New Orleans, Louisiana.
Gayatri
G
Mirani
Center for Biostatistics in AIDS Research Departments of Biostatistics Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
Paige L
PL
Williams
Center for Biostatistics in AIDS Research.
Miriam
M
Chernoff
University of Colorado School of Medicine and Children's Hospital Colorado, Aurora.
Mark J
MJ
Abzug
University of Colorado School of Medicine and Children's Hospital Colorado, Aurora.
Myron J
MJ
Levin
Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
George R
GR
Seage
Rutgers New Jersey Medical School, Newark.
James M
JM
Oleske
Albert Einstein College of Medicine, Bronx-Lebanon Hospital Center, Bronx.
Murli U
MU
Purswani
Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland.
Rohan
R
Hazra
Center for Biostatistics in AIDS Research.
Shirley
S
Traite
Frontier Science Technology and Research Foundation, Amherst, New York.
Bonnie
B
Zimmer
Tulane University School of Medicine, New Orleans, Louisiana.
Russell B
RB
Van Dyke
D015526:AIDS Dementia Complex / Q000453:epidemiology / Q000401:mortality; D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology* / Q000401:mortality*; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000401:mortality*; D006801:Humans; D015994:Incidence; D008297:Male; D008659:Metabolic Diseases / Q000453:epidemiology / Q000401:mortality; D009026:Mortality; D011446:Prospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
D044966:Anti-Retroviral Agents
mortality; opportunistic infections; pediatric HIV; pregnancy; psychiatric