Study Finds Youth Living With HIV Less Likely Than Adults to Achieve Viral Suppression

Despite similar rates of enrollment in medical care, youth living with HIV have significantly lower rates of viral suppression (reducing HIV to undetectable levels) than adults over age 24, according to a recent analysis. Researchers analyzed data from the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN), which is funded by NIMHD, NICHD, and NIDA.

Among 1,411 youth recently enrolled in treatment centers in the United States, researchers found that only 12% attained viral suppression—a much lower rate than the 32% to 63% suppression rate observed in adults over age 24. The data also suggest that the amount of time between HIV diagnosis and enrollment in care may be an important factor. The findings highlight the need for youth-focused interventions to promote initiation and adherence to antiretroviral therapy in this population.

The HIV Continuum of Care for Adolescents and Young Adults Attending 13 Urban US HIV Care Centers of the NICHD-ATN-CDC-HRSA SMILE Collaborative

Bill G Kapogiannis, Linda J Koenig 1, Jiahong Xu 2, Kenneth H Mayer 3, Jacqueline Loeb 2, Lauren Greenberg 2, Dina Monte 2, Marinna Banks-Shields 4, J Dennis Fortenberry 5, Adolescent Medicine Trials Network for HIV/AIDS Interventions

Affiliations

PMID: 32267659
PMCID: PMC7147723 (available on 2021-05-01)
DOI: 10.1097/QAI.0000000000002308

Abstract

Background: Almost one-quarter of all new HIV diagnoses in the United States occur among persons aged 13-24 years. These youths have the poorest HIV care continuum (HCC) outcomes, yet few empirical youth-specific data are available.

Methods: The Strategic Multisite Initiative for the Identification, Linkage, and Engagement in Care of HIV-infected youth (SMILE) helped HIV-infected (mostly newly diagnosed) youth, aged 12-24 years, link to youth-friendly care, and evaluated each milestone of the HCC (October 2012-September 2014). Numbers of HIV-infected youth referred, linked, engaged, and retained in care were recorded, along with sociodemographics. Viral suppression (VS) was defined as ≥1 HIV viral load (VL) below the level of detection on study. Correlates of VS were examined using Cox proportional hazards models.

Results: Among 1411 HIV-infected youth, 1053 (75%) were linked, 839 (59%) engaged, and 473 (34%) retained in care at adolescent health care sites. Antiretroviral therapy was initiated among 474 (34%), and 166 (12%) achieved VS. Predictors of VS included lower VL at baseline [aHR 1.56 (95% CI: 1.32-1.89), P < 0.0001], recent antiretroviral therapy receipt [aHR 3.10 (95% CI: 1.86-5.18), P < 0.0001], and shorter time from HIV testing until referral to linkage coordinator [aHR 2.52 (95% CI: 1.50-4.23), P = 0.0005 for 7 days to 6 weeks and aHR 2.08 (95% CI: 1.08-4.04), P = 0.0294 for 6 weeks to 3 months compared with >3 months].

Conclusions: Although this large national sample of predominately newly diagnosed youths linked to care at similar rates as adults, they achieved disproportionately lower rates of VS. Prompt referral to youth-friendly linkage services was an independent predictor of VS. Youth-focused interventions are urgently needed to improve their HCC outcomes.