title: Changes in Advanced Immunosuppression and Detectable HIV Viremia Among Perinatally HIV-Infected Youth in the Multisite United States HIV Research Network.
abstract: 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/mm(3) 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/mm(3). 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 PHIV-infected youth. Factors associated with advanced immunosuppression and viremia offer the chance to define strategies to optimize outcomes.
authors.affiliation: Division of Pediatric Infectious Diseases, Department of Pediatrics, and Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, and ageorg10@jhmi.edu.
authors.forename: Allison L
authors.initials: AL
authors.lastname: Agwu
authors.affiliation: Center for Financing, Access, and Cost Trends, Agency for Health Care Research and Quality, Rockville, Maryland.
authors.forename: John A
authors.initials: JA
authors.lastname: Fleishman
authors.affiliation: Division of General Pediatrics, Children's Hospital of Philadelphia, Pennsylvania; and Departments of.
authors.forename: Richard
authors.initials: R
authors.lastname: Rutstein
authors.affiliation: Internal Medicine Public Health and Preventive Medicine, Oregon Health and Science University, Portland.
authors.forename: P Todd
authors.initials: PT
authors.lastname: Korthuis
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, and.
authors.forename: Kelly
authors.initials: K
authors.lastname: Gebo
keywords: Immunosuppression; Outcomes; Perinatally HIV-Infected; Youth