At age 18, youth with HIV may have a shorter lifespan compared to youth without HIV, suggests a simulation by researchers funded by the National Institutes of Health (NIH). Estimates ranged from roughly 10 to 20 lost years depending on sex assigned at birth, whether HIV was present at birth or acquired later, and whether youth received ideal HIV care. The authors concluded that interventions focusing on HIV care and social factors are needed to improve life expectancy for youth with HIV in the United States.
The research team was led by Anne M. Neilan, M.D., of Massachusetts General Hospital. The work appears in JAMA Health Forum. NIH funding was provided by NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and National Institute of Allergy and Infectious Diseases.
Background
According to the most recent estimates from the Centers for Disease Control and Prevention, there are approximately 42,000 U.S. youth ages 13 to 24 years old living with HIV. They include youth who acquired HIV in the womb or around the time of birth, also called perinatal HIV (PHIV), and youth who acquired HIV sometime after birth, or non-perinatal HIV (NPHIV).
These groups differ in ways that may influence their health. Youth with PHIV may have begun treatment with HIV regimens that are now outdated or may have developed HIV variants that are resistant to treatment. They may also experience challenges transitioning from having an adult caregiver to managing their own care, and they may face a higher risk of long-term complications from HIV and antiretroviral treatments. Youth with NPHIV are more likely to be male at birth, to be men who have sex with men, to have injected drugs, and to have engaged in risky sexual activity.
Results
Life expectancy rates can inform health care policies and the distribution of healthcare resources, including for youth with HIV who are approaching adulthood. For this reason, the study team developed a microsimulation model to compare life expectancy among youth with PHIV, NPHIV, and without HIV. All three groups were modeled with identical racial distributions. The authors also developed scenarios to evaluate the effects of efforts to maintain high CD4 counts (a measure of immune health in HIV), to adhere to antiretroviral treatments, to remain in care, and to return to care after a break. The researchers based their simulations on data from the Adolescent Medicine Trials Network for HIV/AIDS Interventions, the International Maternal, Pediatric Adolescent AIDS Clinical Trials Network, and on the causes of HIV-related death and non-HIV related deaths, which might be influenced by sex assigned at birth, age, race, and ethnicity.
The team found that male youth without HIV had a projected life expectancy of 76.3 years and female youth had a projected life expectancy of 81.7 years. In comparison, male youth with PHIV could expect to live 10.4 years less, and male youth with NPHIV could expect to live 15 years less. Female youth with PHIV had 11.8 fewer projected years, compared to female youth without HIV. Female youth with NPHIV had 19.5 fewer projected years.
For youth receiving ideal HIV care, male and female youth with PHIV could expect a life expectancy about 6 months shorter than those without HIV. However, males with NPHIV could expect 6 fewer years, and females could expect 10.4 fewer years.
Significance
According to the study authors, the findings suggest that the difference between groups with ideal care and without ideal care is not attributable to HIV itself, but rather to systemic, social, and behavioral factors, and that these issues must be addressed to improve life expectancy. For example, the study authors cited poverty, housing, insurance eligibility, transportation, poor coordination of health care between providers and across the health care system, and HIV stigma. The authors added that their findings suggest that all youth with HIV would benefit from interventions to improve engagement in HIV care.
Reference
Neilan, AM, et al. Projected life expectancy for adolescents with HIV in the US. JAMA Health Forum. 2024.
BACK TO TOP