Receipt of clinical and prevention services, clinical outcomes, and sexual risk behaviors among HIV-infected young adults in care in the United States

Abstract

We describe receipt of clinical and prevention services, clinical outcomes and sexual risk behaviors among young adult HIV patients in the United States during 2009-2013, using a sample designed to produce nationally representative estimates. Compared with older HIV patients, proportionately more young adults received provider-delivered prevention services and reported sexual risk behaviors. Young adults had similar care patterns as older HIV patients, but were less likely to have or adhere to an antiretroviral therapy prescription and achieve viral suppression. These estimates establish a national baseline from which to monitor changes in clinical outcomes and transmission behaviors among young HIV-infected adults.

Longitudinal virological outcomes and factors associated with virological failure in behaviorally HIV-infected young adults on combination antiretroviral treatment in the Netherlands, 2000 to 2015

“…The subgroup of young adults within the HIV population show lower rates of achieving and maintaining HIV viral suppression as compared to older patients. [3] As such, they are at increased risk for the development of drug resistant mutations reducing future treatment options. [4] The development of independence, self-consciousness, and autonomy (hallmarks of adolescence and young adulthood) threaten optimal and durable treatment of all young adults that have to cope with a chronic condition.…”

“…Cross-sectional studies from the United States report relatively low HIV suppression rates from 63.6% to 74% in young adults living with HIV on cART, as compared to 81% in older adults. [3,11] Maintenance of viral suppression is even more challenging in young adults as well as in adolescents, as reflected by higher rates of virological rebound and lower durable viral suppression rates as compared to older adults. [3,12] Factors associated with effective viral suppression were consistent linkage to HIV care, >6 months of antiretroviral treatment (ART) and >90% adherence.…”

Trends in ART Prescription and Viral Suppression Among HIV-Positive Young Adults in Care in the United States, 2009–2013

“…The characteristics of HIV-positive young adults in care in the United States during 2009–2013 have been reported elsewhere (4), but overall among the pooled dataset (n=636) 43% (95% confidence interval [CI] 37–50) were black men. The majority had a gay or bisexual identity (62%, CI 57–67) and were living in households at or below the poverty level (62%, CI 56–66).…”

“…During this time period, guidelines for initiating ART steadily moved away from using CD4 count as a criterion for initiation (8), and our data may reflect increasing provider adoption of these guidelines. Providers have often cited concerns about treatment readiness and other barriers to adherence as a reason to defer ART initiation for otherwise clinically-eligible young people (20, 21), who on average report lower adherence than older persons (4). However, providers may have grown less concerned about nonadherence as a reason to defer therapy among young adults because of the increasing evidence of the benefits of early ART and the availability of better regimen options that are more forgiving of nonadherence (9).…”

“…Only 13% of HIV-positive young adults are estimated to be virally suppressed (3) and, even among those receiving medical care, HIV-positive young adults are less likely than older adults to take antiretroviral therapy (ART), be adherent, and be virally suppressed (4–6). Agwu and colleagues found evidence of increasing ART use and decreasing viremia from 2002 to 2010 among a cohort of youth living with HIV who were perinatally-infected (7).…”