Abstract
BACKGROUND: Data on mortality, clinical events, viral load (VL), and immunosuppression among young adults aging with perinatally acquired human immunodeficiency virus (YAPHIV) are limited. METHODS: Among YAPHIV ≥ 18 years in the Pediatric HIV/AIDS Cohort Study, we calculated incident mortality, CDC-C/WHO-4 rates, and proportion of person-years (PY) with elevated VL (≥200 copies/mL) and immunosuppression (CD4 < 200 cells/mm(3)) by age strata 18-21, 22-25, 26-29, and ≥30 years. We compared mortality rates to the US population and identified predictors of mortality/CDC-C/WHO-4 events at age ≥ 25 years. RESULTS: Six hundred seventeen participants had median follow-up of 6.5 years; at baseline, 63% were 18-21 years, 61% were female, 63% self-reported as Black, median CD4 count was 561 cells/mm(3), and 66% had VL < 200 copies/mL. Mortality was highest at ≥30 years (8.1 per 1000PY [95% CI: 3.0, 22.0]). Black YAPHIV had mortality rates at least 7.1 (3.0, 17.1) times higher than white non-Hispanic persons in the US population. Proportion of elevated VL person-time decreased while low CD4 person-time increased as participants aged. Among 307 participants followed after age ≥ 25 years, elevated VL, low CD4, and prior CDC-C/WHO-4 event strongly predicted risk of incident mortality/CDC-C/WHO-4 event (C-index: 0.94); risk at 3 years of follow-up was 19% (0%, 45%) among those with all 3 characteristics. Other important predictors were poor treatment adherence, current cannabis use, lack of current employment/education, and stressful events (C-index: 0.81). CONCLUSIONS: There is excess mortality with age for YAPHIV, particularly for Black YAPHIV. Interdisciplinary interventions are needed to improve treatment outcomes for YAPHIV at highest identified risk.