Lower CD4 Cell Counts Put Perinatally HIV-Infected Youth at Risk

Although patients with HIV typically could experience additional health problems at any age, a report from Massachusetts General Hospital (MGH) found that becoming infected with the virus around the time of birth carries serious health risks.

There are currently around 10,000 people who were perinatally infected with HIV living in the United States. The researchers looked at 1,446 of these patients gathered from 2 studies. Not only did the study conclude that these patients have other health problems and worse HIV control, but they also have an increased risk of death.

“Despite being engaged in health care, the number of deaths among youth born with HIV in the US is 6 to 12 times higher than for youth without HIV of the same age, sex, and race,” lead author, Anne Neilan, MD, MPH, (photo) of the MGH Division of Infectious Diseases and the Medical Practice Evaluation Center, said in a news release.

The study group included 759 females (52.5%) and 953 African Americans (65.9%) ages 7 to 30 (average age of 14.6 years). They were enrolled at 41 sites in 12 states and Puerto Rico. There were 2 studies, the Pediatric HIV/AIDS Cohort Study (PHACS) Adolescent Master Protocol and International Maternal Pediatric Adolescent AIDS Clinical Trials (IMPAACT) P1074. The team estimated event rates during person-time for age periods (7 to 12, 13 to 17, and 18 to 30), CD4 cell count (<200, 200 to 499, and >500/mL), and a combined measure of viral load (<400 or >400 copies/mL) and antiretroviral therapy status (either on or off the treatment).

“This is the first generation of perinatally HIV-infected youth living to adulthood, and they are some of the most inspirations, resilient individuals you have ever met,” said co-author, George Seage III, DSc, of the Harvard T. H. Chan School of Public Health.

Over the average follow-up of 4.9 years, there were higher incidences of stage B and C events, as defined by the US Centers for Disease Control and Prevention (CDC), as well as bacterial infections for patients with lower CD4 cell counts. The researchers noted that this was expected.

Compared to the 7 to 12 year olds, the older participants (ages 13 to 17 and 18 to 30) had spent more time with a viral load of >400 copies/mL (22%, 30%, and 44% of person-time, respectively). The older participants also had more time spent with a CD4 cell count of <200 mL (2%, 5%, and 18% of person-time, respectively).

“Adolescents infected with HIV — either at birth or later in life – experience poorer health outcomes compared to adults with HIV in nearly every respect,” Neilan continued. “The good news is that among those with good HIV control, serious health problems are rare.”

Lower CD4 cell counts also correlated with higher rates of sexually transmitted infections.

“This may suggest a biological mechanism for increased STDs or may reflect that patients who have difficulty with their medications are also engaging in more frequent risky sexual behaviors,” said senior author, Andrea Ciaranello, MD, MPH, of the MGH Division of Infectious Disease.

The researchers advise that strengthen services for adolescents and young adults, as well as understanding their special needs, can help tackle HIV stigma and get patients on antiretroviral therapy.

The study, “Association of Risk of Viremia, Immunosuppression, Serious Clinical Events, and Mortality With Increasing Age in Perinatally Human Immunodeficiency Virus—Infected Youth,” was published in the Journal of the American Medical Association (JAMA) Pediatrics. The news release was provided by MGH.

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