High mortality in adolescents and young adults with perinatally-acquired HIV in Thailand during the transition to adulthood
Pradthana Ounchanum, Linda Aurpibul, Sirinya Teeraananchai, Pagakrong Lumbiganon, Wipaporn Natalie Songtaweesin, Tavitiya Sudjaritruk, Kulkanya Chokephaibulkit, Supattra Rungmaitree, Pope Kosalaraksa, Tulathip Suwanlerk, Jeremy Ross, Annette H. Sohn, Thanyawee Puthanakit
Abstract
Transitioning from pediatric to adult care remains a challenge for adolescents and young adults with perinatally-acquired HIV (AYA-PHIV). We assessed treatment outcomes and mortality among Thai AYA-PHIV. The study included AYA-PHIV who reached age 18–24 years who started antiretroviral treatment during childhood at five pediatric HIV clinics across Thailand. From November 2020–July 2021, data were gathered from a cohort database, medical records, and the Thai National AIDS Program. Of 811 eligible AYA-PHIV, 93% were alive; median age 22.3 years (IQR 20.6–23.7), treatment duration 16.1 years (IQR 13.4–18.0). Current HIV care was provided in adults (71%) and pediatric clinics (29%). Treatment regimens included non-nucleoside reverse transcriptase inhibitors (55%), protease inhibitors (36%), and integrase inhibitors (8%); 78% had HIV RNA <200 copies/ml. Of the 7.0% who died, median age at death was 20.8 years (IQR 20.6–22.1); 88% were AIDS-related death. Mortality after age 18 was 1.76 per 100-person years (95% confidence interval 1.36–2.28). Those with CD4 <200 cell/mm3 at age 15 had higher risk of mortality (adjusted hazard ratio 6.16, 95% CI 2.37–16.02). In conclusion, the high mortality among Thai AYA-PHIV indicated the need for better systems to support AYA-PHIV during the transition to adulthood.