Clinical and epidemiological characteristics of young people with perinatal HIV infection

An increasing number of young adults with perinatal HIV infection (PHIV) are reaching adulthood and transitioning to adult care networks for continued treatment. Data on the disease course in adult PHIV patients tracked longitudinally from diagnosis is limited.

Objective. To perform a clinical and laboratory analysis of the course of HIV infection in young adults infected perinatally.

Materials and Methods. This retrospective-prospective study included 105 PHIV patients aged 18-25 years (50.4% male, 49.6% female) registered at the St. Petersburg AIDS Center. The study employed epidemiological (duration of infection, timing of diagnosis and ART initiation), clinical (assessment of HIV disease stage using CDC-1994 and Russian Federation-2006 classifications), and laboratory (analysis of CD4+ lymphocyte counts, HIV RNA levels, detection of antiretroviral drug (ARV) resistance over time) research methods. Statistical analysis was performed using STATISTICA 10, with statistical significance set at p < 0.05.

Results. The mean age at HIV diagnosis was 2.6±4.3 years. By age 6, 70% of children already had advanced disease stages (CDC-1994 stages B3 and C). The mean age at ART initiation was 7.2±4.5 years. An inverse correlation was found between delayed ART initiation and the severity of immunodeficiency (r = -0.42, p < 0.001). In the first ART regimen, 95.2% of children received protease inhibitors (PIs). The mean number of ART regimens per child during follow-up was 3.4±1.08 (min=2, max=7). At transition to adult care, 22% of patients had immunodeficiency of varying severity; this prevalence increased to 25.6% after 3 years of observation. Post-transition, 22% of patients were lost to follow-up (LTFU). The use of fixed-dose combinations (FDCs) significantly improved treatment adherence (p < 0.05). High adherence was associated with female gender (increased odds by 3.8 times, p < 0.01), while low adherence was associated with an HIV infection duration exceeding 20 years (risk of low adherence increased by 2.8 times, p < 0.05).

Conclusion. Perinatal HIV infection in this cohort resulted from: low coverage of preventive measures, high rates of substance use and HCV co-infection among the mothers, and low adherence to antenatal monitoring and treatment during pregnancy. The absence of clear, regulated timelines for early HIV testing in children led to late diagnosis. Treatment initiation criteria followed a watchful waiting approach, resulting in delayed ART initiation for a significant proportion of children, often amidst progressive immunodeficiency. Most children started ART late, against a background of advanced HIV stages and varying degrees of immunodeficiency. Threequarters of PHIV patients demonstrated good adherence to prescribed ART after transitioning to adult care, while onequarter were lost to follow-up.

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