Background: Young adults with HIV (YAHIV) are less likely to be retained in care or achieve viral suppression when seen in adult clinics. We assessed outcomes of a youth focused care model versus standard of care within a large adult HIV clinic. Setting: The Accessing Care Early (ACE) program for YAHIV is embedded within an adult clinic. Eligibility for ACE includes age 18-30 years with ≥1 criteria: transfer from pediatric care, mental health diagnosis, substance use, or identified adherence barriers. Ineligible patients receive standard of care (SOC). Methods: Retrospective analysis of patients entering ACE vs SOC from 2012-2014. Multivariable logistic regression assessed variables associated with retention and viral suppression (VS) < 200 copies/mL, and in separate analysis, clinical services utilization. Results: 137 YAHIV entered care (2012-2014), 61 ACE and 76 SOC. Despite higher risk factors, ACE YAHIV were less likely to be lost to follow up compared to SOC (16% vs. 37%, p<0.01). At 24 months 49% in ACE vs. 26% in SOC met the retention measure, (p<0.01). In adjusted analysis ACE was associated with retention in care (AOR 3.26 [1.23-8.63]). Of those meeting the retention measure, 60% of ACE versus 89% of SOC had VS (AOR 0.63 [0.35-1.14]). Retention was associated with more frequent social work visits, nurse phone calls, and peer navigator interactions. Conclusions: Higher risk ACE YAHIV had better retention than SOC YAHIV in an adult clinic. Improved retention did not to lead to improved VS, underscoring the need for additional interventions to optimize VS for YAHIV.

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Recent studies suggest that HIV-specific antibody-dependent cell-mediated cytotoxicity (ADCC) antibodies contribute to protective immunity against HIV. An important characteristic of future HIV vaccines will, therefore, be the ability to stimulate production of these antibodies in both men and women. Early studies suggest that men may have a better ADCC antibody response against HIV than women. Our objective was to determine whether men and women differ with respect to their ADCC response to HIV-1 gp120. HIV-positive, asymptomatic untreated men and women were matched for race, age, CD4+ T cell number, HIV-1 viral load, and treatment and HIV-1 gp120 ADCC antibody titers were compared. A standard 51 Cr-release assay was used to determine HIV-1 gp120 ADCC antibody titers in HIV-1-seropositive individuals from the Multicenter AIDS Cohort Study (MACS; n = 32) and the Women's Interagency HIV Study (WIHS; n = 32). Both sexes had high ADCC titers against HIV-1 gp120: 34.4% (n = 11) and 40.6% (n = 13) of men and women, respectively, had titers of 10,000; 62.5% (n = 20) and 56.3% (n = 18) had titers of 100,000. Groups did not differ in percent specific release (% SR), lytic units (LU), correlations of titer to viral load, or titer to CD4 + T cells in men or women. Both groups also had similar cross-clade ADCC antibody responses ( p > 0.5 for % SR and LU). Comparable groups of asymptomatic HIV-1-infected men and women had comparable HIV-1 gp120 ADCC antibodies. Both sexes had significant cross-clade reactivity. Differences between men and women may become evident as disease progresses; this should be evaluated at later stages of HIV-1 infection.

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