Adolescents and young adults with early acquired HIV infection in the united states: unique challenges in treatment and secondary prevention

ABSTRACT

Introduction

Worldwide, children who acquired human immunodeficiency virus (HIV) at an early age, either perinatally or through blood transfusion, are reaching adolescence and adulthood due to successful antiretroviral treatment (ART). While many are thriving, a significant proportion face unprecedented multilevel challenges that can affect their long-term outcomes. Specifically, longstanding and poorly controlled HIV resulting from inadequate early regimens and nonadherence, along with the toxicities of some ART agents, can predispose them to sequelae including HIV-associated complications and other comorbidities.

Areas covered

This paper reviews and summarizes the unique issues facing adolescents and young adults with early acquired HIV (AYA-EAHIV), including ART challenges, emerging comorbidities, and complications, including mental health comorbidities, secondary prevention, and transition from pediatric/adolescent to adult care.

Expert opinion

AYA-EAHIV are a special population that have lived their entire lives with the physical and psychological toll of HIV mandating targeted and purposeful approaches to optimize their management and outcomes. Multifaceted inclusive and context-specific approaches focusing on heightened research, risk reduction interventions, and ‘outside the box’ thinking will be required to optimize treatment and reduce morbidity and mortality.

KEYWORDS:

• Early acquired HIV
• perinatal HIV
• secondary prevention
• risk reduction
• virologic suppression
• adherence
• chronic HIV
• comorbidities
• adolescent
• young adult

Article highlights

• AYA-EAHIV are a unique population who acquired HIV infection in-utero/early infancy.

• Challenges arising from non-adherence, loss to follow-up, non-disclosure etc. are common among AYA-EAHIV as they transition from childhood into adulthood.

• Sexuality and sexual exploration, both normal phases of development may increase the risk of vertical or horizontal transmission when poorly managed.

• Complications and comorbidities also occur in AYA-EAHIV and are amplified by chronic immune stimulation and chronic ARV use.

• Renewed efforts at optimizing treatment and addressing adherence challenges are required for improved outcome and longevity of AYA-EAHIV.

Declaration of interest

A Agwu receives funding from Johns Hopkins Center for AIDS Research (P30AI094189). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

The Tech2Check study is funded by the National Institute of Minority Health and Health Disparities (NIMHD) (R01 MD11770 (Principal investigators Trent and Agwu)).