Mandsager et al.1 note that despite improvements in viral suppression rates across specific client subpopulations served by the national Ryan White HIV/AIDS Program (RWHAP), disparities by age continue, with the lowest rates of viral suppression among adolescents and young adults (AYA) aged between 13 and 24 years. We would like to share data from our national cohort of AYA living with perinatal HIV infection to highlight that there is additional disparity in viral suppression rates among those aged 13 to 24 years and those aged 25 to 34 years by perinatal HIV infection.
While the population of AYA with perinatal HIV infection in the United States is relatively small, they are unique in their life-long experience with HIV infection, with many born in the era of mono- and dual-antiretroviral therapy, thus increasing their likelihood of drug resistance. AYA with perinatal infection also have the challenge of maintaining life-long adherence to antiretroviral medication while additionally dealing with transitioning to adult care; experiencing depression, isolation, and stigma; and coping with parental loss. It is therefore not surprising that viral suppression rates among AYA with perinatal infection are lower than those observed overall by Mandsager et al. Specifically, among 337 AYA aged 13 to 24 years with perinatal HIV infection enrolled in the US-based Pediatric HIV/AIDS Cohort Study (PHACS; www.phacsstudy.org), 66.2% (95% confidence interval = 60.9%, 71.2%) were virally suppressed between 2016 and 2018 compared with 71.1% among those aged 13 to 24 years in the RWHAP. Among 184 young adults aged 25 to 34 years with perinatal HIV infection in PHACS, 71.7% (95% confidence interval = 64.7%, 78.1%) were suppressed compared with 77.6% in the RWHAP.
It is important to note that there are sociodemographic characteristics that differ between AYA with perinatal infection and the overall RWHAP client population. Of the total 521 AYA with perinatal infection who were aged 13 to 34 years in the PHACS study, 70.3% identified as Black compared with 47.1% of RWHAP clients, and 61.4% were female compared with 27.3% of RWHAP clients. We would need to take these differences into account to directly compare our estimates of viral suppression among AYA with perinatal infection with those of the RWHAP client population given existing disparities in viral suppression by race and gender. However, if possible, given the data acquired through the RWHAP Services Report, we suggest that viral suppression data among AYA served by the RWHAP be stratified by perinatal HIV infection as there appear to be disparities that would be important to address when targeting interventions aimed at improving viral suppression among youths.
ACKNOWLEDGMENTS
The Pediatric HIV/AIDS Cohort Study (PHACS) is funded by the National Institutes of Health, under cooperative agreements HD052104 (PHACS Coordinating Center, Tulane University School of Medicine) and HD052102 (PHACS Data and Operations Center, Harvard T. H. Chan School of Public Health).
We thank the study participants, clinical sites, the PHACS Adult and Young Adult Community Advisory Boards, Frontier Science & Technology Research Foundation, and Westat. Complete acknowledgments for PHACS can be found at https://www.phacsstudy.org/About-Us/Funding-Acknowledgements.
Note. The conclusions and opinions expressed in this article are those of the authors and do not necessarily reflect those of the National Institutes of Health or US Department of Health and Human Services.
CONFLICTS OF INTEREST
The authors declare no conflicts of interest.
HUMAN PARTICIPANT PROTECTION
The Adolescent Master Protocol and AMP Up protocol of PHACS were approved by the institutional review boards at the Harvard T. H. Chan School of Public Health and at each participating site. Written informed consent was obtained from each participant’s parent or legal guardian. Assent was obtained from child participants according to local institutional review board guidelines.
REFERENCES
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