1. Changing Trends in Complications and Mortality Rates Among US Youth and Young Adults With HIV Infection in the Era of Combination Antiretroviral Therapy
- Author
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Michele Kelly, Yolanda Gonzalez, Julie McAvoy, Nancy Flores, Lynn Heald, Myron J. Levin, Mark J. Abzug, Siham Akleh, Kenneth M. Boyer, Aditya Kaul, Yvonne J. Bryson, Susan Lovelace, Ruth Santos-Otero, Wanda Marrero-Figueroa, Catherine Kneut, Saniyyah Mahmoudi, Katherine M. Knapp, Margaret Donnelly, Mahrukh Bamji, Barbra Murante, Carina Rodriguez, John Swetnam, Kaye Park, Tempe Chen, Russell B. Van Dyke, Donna Picard, Jaime G. Deville, Michael G. Rosenberg, Chivon McMullen-Jackson, William Borkowsky, Ana Puga, Diane W. Wara, Karin Nielsen, Ellen R. Cooper, Marlene Burey, Alicia Marion, Eva Operskalski, Michele Carter, Geoffrey Weinberg, James Homans, Amanda Robson Nuss, Marvin Belzer, Maureen Haak, Jagmohan Batra, Arry Dieudonne, Indu Pathak, Kimberly Norris, Shirley Traite, Eric McGrath, Sunita Patil, Charlotte Mao, Steven D. Douglas, Miriam Chernoff, Mary E. Paul, Audra Deveikis, Rohan Hazra, Nizar Maraqa, Michael Bolaris, Nicolas Rosario-Matos, Allison L. Agwu, James Oleske, Theodore Ruel, Katherine Luzuriaga, Lizbeth Fabregas, Savita Manwanim, Sharon Nachman, Patricia C. Houston, Ann J. Melvin, Thomas Alchediak, Mica Muskat, Claudia Florez, Gloria Bowen, Chandni Parikh, Newana Beatty, Zulma Eysallenne, Jamie Martinez, Nagamah S Deygoo, Tabetha Gayton, Margaret Keller, Irma Febo, Connie Trexler, Mobeen H. Rathore, Andrea Kovacs, Kerry Hahn, Carlos Ortega, James Blood, Jennifer Dunn, Maria Johnson, Murli Purswani, Sheila Bradford, Erin Infanzon, Chokechai Rongkavilit, James M. Oleske, Joan Wilson, Diane Tucker, Denise Casey, Judy Glenn, Jesica Pagano-Therrien, Michelle Del Rey, Sharan Robbins, Patricia M. Flynn, Sandra K. Burchett, Sheri McDougall, William T. Shearer, Margaret Ann Sanders, Dorothy Shaw, David Michalik, Nicole Tilton, Pablo Leitz, Ram Yogev, Lisa Stangl, Gayatri Mirani, Diana F Clarke, Stephen A. Spector, Debra McLaud, Patricia Emmanuel, Christina Hermos, Amy Inman, Hannah Bernath, Marilyn J. Crain, Charles D. Mitchell, Ekta Patel, Joanna Dobroszycki, Richard M. Rutstein, Corinda Hilyard, James B. McAuley, Levi Cherian, Carol Vincent, Bonnie Zimmer, Anna Marie Emeh, Denise Ferraro, Douglas Watson, Judy Hayes, Grace Alvarez, Sohail Rana, Rolando M. Viani, LaShonda Spencer, Maritza Cruz-Rodriguez, Margarita Silio, Thuy Anderson, Aleisha Collinson-Streng, Carrie Pettler, Anthony Scolpino, Nancy Karthas, Ruth Williams, Karen Kassen, Paige L. Williams, Steven Zeichner, Jennifer Englund, Mary Elizabeth Vachon, Gwendolyn B. Scott, George R. Seage, Thomas Wride, Linda Bettica, Caroline Reed, and Ayanna Walters
- Subjects
Microbiology (medical) ,Adult ,Male ,medicine.medical_specialty ,Pediatrics ,AIDS Dementia Complex ,Adolescent ,AIDS-Related Opportunistic Infections ,Population ,HIV Infections ,Young Adult ,Metabolic Diseases ,Risk Factors ,Antiretroviral Therapy, Highly Active ,medicine ,Humans ,Prospective Studies ,Young adult ,Mortality ,education ,Prospective cohort study ,education.field_of_study ,business.industry ,Incidence (epidemiology) ,Mortality rate ,Incidence ,Age Factors ,United States ,Surgery ,Infectious Diseases ,Standardized mortality ratio ,Anti-Retroviral Agents ,Female ,business ,Cohort study - Abstract
Background Combination antiretroviral therapy (cART) has resulted in a dramatic decrease in human immunodeficiency virus (HIV)-related opportunistic infections and deaths in US youth, but both continue to occur. Methods We estimated the incidence of complications and deaths in IMPAACT P1074, a long-term US-based prospective multicenter cohort study conducted from April 2008 to June 2014. Incidence rates of selected diagnoses and trends over time were compared with those from a previous observational cohort study, P219C (2004-2007). Causes of death and relevant demographic and clinical features were reviewed. Results Among 1201 HIV-infected youth in P1074 (87% perinatally infected; mean [standard deviation] age at last chart review, 20.9 [5.4] years), psychiatric and neurodevelopmental disorders, asthma, pneumonia, and genital tract infections were among the most common comorbid conditions. Compared with findings in P219C, conditions with significantly increased incidence included substance or alcohol abuse, latent tuberculosis, diabetes mellitus, atypical mycobacterial infections, vitamin D deficiency or metabolic bone disorders, anxiety disorders, and fractures; the incidence of pneumonia decreased significantly. Twenty-eight deaths occurred, yielding a standardized mortality rate 31.5 times that of the US population. Those who died were older, less likely to be receiving cART, and had lower CD4 cell counts and higher viral loads. Most deaths (86%) were due to HIV-related medical conditions. Conclusions Opportunistic infections and deaths are less common among HIV-infected youth in the US in the cART era, but the mortality rate remains elevated. Deaths were associated with poor HIV control and older age. Emerging complications, such as psychiatric, inflammatory, metabolic, and genital tract diseases, need to be addressed.
- Published
- 2015