Sunday, August 7, 2022
HomeHIV/AIDSCritical need for integrated health services in HIV-affected populations

Critical need for integrated health services in HIV-affected populations

Many young adults living with perinatally acquired HIV infection reach young adult milestones related to school, employment and sexual relationships, research shows. "We were pleased to document that so many of these young people are successfully achieving adult milestones despite growing up with HIV infection often under relatively adverse circumstances. It substantiated our experiences as clinicians and provided hope for the millions of children living with HIV globally," Dr Elaine Abrams of Columbia University, Mailman School of Public Health, is quoted in a Medscape report as saying.

However, the study also found that both young adults with perinatally acquired HIV, and their peers who were exposed perinatally to HIV but are uninfected, have high rates of psychiatric and substance-use disorders and behavioural risks, which may jeopardise long-term health and functioning.

"This is one of the first studies on young adult functioning among individuals with perinatally acquired HIV, providing new insights into adult transitions, behavioural health, and health outcomes," Abrams and colleagues note.

Globally, large numbers of people with perinatally acquired HIV are reaching adolescence and young adulthood when they are at increased risk for poor health and behavioural outcomes, the researchers note.

Abrams and colleagues analysed data from the Child and Adolescent Self-Awareness and Health Study (CASAH), a longitudinal cohort of young adults with perinatally acquired HIV (PHIVYAs) and perinatally HIV-exposed but uninfected young adults (PHEUYAs).
They focused on 340 youth who were between 9 and 16 years old at enrolment (206 PHIV and 134 PHEU) and 248 who were between age 18 and 25 at five-year follow up (151 PHIV and 97 PHEU).

Both groups met similar adult milestones: 67% graduated high school or an equivalent, 19% were in college and 42% were employed. However, 38% were neither in school nor working, 12% reported incarceration and 16% had a history of being homeless. Altogether, more than a quarter (27%) had a psychiatric disorder, including mood (11%), anxiety (22%) and substance use (28%), with no difference by HIV status.

Compared with PHEUYAs, PHIVYAs performed worse on two standard tests of executive function (Trail Making Test and Weschler Adult Intelligence Scale Digit Span sub-test). There were no significant differences by HIV status in sexual behaviours. Most young adults in the cohort had started having sex (93%) and 41% reported not using a condom. Among women, 41% reported becoming pregnant, 23% delivered a baby. Among men, 38% reported lifetime pregnancy in a partner.

"Furthermore, despite the availability of a new more potent antiretroviral medications more than a third of the young adults with perinatal HIV infection in the study failed to achieve viral suppression jeopardizing their future health outcomes," Abrams is quoted in the report as saying.

"Given the staggering numbers of PHIVYAs worldwide, our findings reveal a critical need for integrated mental health, substance use, and health services for HIV-affected populations. With our findings, we also draw attention to the growing population of PHEUYAs that warrants similarly urgent opportunities for prevention and treatment," the researchers write.

Abstract
Background: Young adults living with perinatally acquired HIV infection (PHIVYAs) are at risk for poor biomedical and behavioral health outcomes. Few studies offer a comprehensive overview of the functioning of this population in young adulthood and the role of HIV.
Methods: Data come from the Child and Adolescent Self-Awareness and Health Study, a longitudinal behavioral health cohort study of PHIVYAs and perinatally HIV–exposed but uninfected young adults (PHEUYAs) who are compared on psychiatric and neurocognitive functioning, sexual and substance use behaviors, health and reproductive outcomes, and young adult milestones.
Results: Overall, 27% of participants met criteria for a psychiatric disorder, including mood (11%), anxiety (22%), and substance use (28%), with no HIV status differences. PHIVYAs performed worse on 2 neurocognitive tests. There were no HIV status differences in condomless sex (41%) or pregnancies (41% women; 38% men). Both groups exhibited similar adult milestones: 67% graduated high school or an equivalent, 19% were in college, and 42% were employed. However, 38% were neither in school or working, 12% reported incarceration, and 16% were ever homeless. Among PHIVYAs, 36% were viremic (>200 copies per mL), and 15% were severely immunocompromised (CD4+ cell count <100 cells per mm3).
Conclusions: Many PHIVYAs achieve adult milestones related to school, employment, sexual relationships, and starting families. However, they and PHEUYAs have high rates of psychiatric and substance use disorders and behavioral risks, which can jeopardize long-term health and adult functioning, particularly in the context of HIV. These findings underscore an urgent need to escalate interventions.

Authors
Elaine J Abrams, Claude A Mellins, Amelia Bucek, Curtis Dolezal, Jeannette Raymond, Andrew Wiznia, Andrea Jurgrau, Mahrukh Bamji, Cheng-Shiun Leu, Yiu Kee Warren Ng

[link url="https://www.medscape.com/viewarticle/900530?src=wnl_edit_tpal&uac=217856CJ&impID=1712238&faf=1"]Medscape report[/link]
[link url="http://pediatrics.aappublications.org/content/early/2018/08/08/peds.2018-0938?sso=1&sso_redirect_count=2&nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR%3A%20No%20local%20token&nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR%3a+No+local+token"]Paediatrics abstract[/link]

Subscribe to our Newsletter

Receive Medical Brief's free weekly e-newsletter.

* indicates required