Anne M. Neilan, M.D., MPH, Fellow, Infectious Diseases, Massachusetts General Hospital, Boston.
By Robert Preidt
Teens and young adults who were infected with HIV near the time of birth are at increased risk for serious health problems and death, a new study finds.
“Despite being engaged in health care, the number of deaths among youth born with HIV in the U.S. is six to 12 times higher than for youth without HIV of the same age, sex and race,” said study leader Dr. Anne Neilan. She is an infectious disease fellow at Massachusetts General Hospital in Boston.
Neilan and her hospital col-leagues analyzed 2007-2015 data from more than 1,400 young Americans who were infected with HIV — the virus that causes AIDS — when they were born.
Those between the ages of 13 and 30 were more likely to have what doctors call poor HIV control. That means they had higher levels of the virus and lower levels of the immune cells that HIV targets. They also were more likely to have AIDS-related illnesses and die.
Of those between 18 and 30 years of age, 35 percent had poor HIV control. That makes them more likely to become resistant to some HIV medications and transmit HIV to others.
“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 said in a hospital news release. “The good news is that among those with good HIV control, serious health problems are rare.”
Along with HIV-related health issues, the most commonly reported problems among patients in the study were mental health disorders and nervous system development. Many women also had sexually transmitted diseases (STDs), possibly related to a weakened immune system.
“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,” study senior author Dr. Andrea Ciaranello said in the news release. Ciaranello practices in the Division of Infectious Disease at Mass General.
The study was published online March 27 in the journal JAMA Pediatrics.
About 10,000 young people in the United States were infected with HIV at birth, and most are now over age 18. Due to the use of antiretroviral therapy, fewer than 200 U.S. babies a year are born with HIV now, the researchers said.
But better care is needed for
young people who have HIV, Neilan said. “That might include youth-friendly services that consider the substantial stigma many of these patients face, novel approaches to antiretroviral therapy delivery, and improving support for youth transitioning from pediatric to adult health care providers,” she said.