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Discordance in HAART Utilization Rates in HIV-1-infected Adolescents in a Multi-site US Cohort
Allison Agwu*1, J Ellen1, R Rutstein2, A Gaur3, S Spector4, R Warford5, G Siberry1, K Gebo1, and for the HIV Research Network
1Johns Hopkins Univ, Baltimore, MD, US; 2Children`s Hosp of Philadelphia, PA, US; 3St Jude Children`s Res Hosp, Memphis, TN, US; 4Univ of California, San Diego, US; and 5St Luke`s Roosevelt Hosp, New York, NY, US
Background: HIV-1 incidence is rising among
adolescents and young adults vertically-infected children are surviving longer and
adolescents are acquiring infections through risky behaviors. We examined HAART
utilization patterns in adolescents currently in care and meeting treatment
criteria.
Methods: During 2005, data were collected for 699
adolescents (aged 12 to 24 years) from 20 adult and pediatric HIV Research
Network (HIVRN) sites. Patients were stratified by risky behaviors vs vertical
infection. Demographic, immune, virologic, HAART and opportunistic
infection prophylaxis utilization were then assessed using a
cross sectional analysis. Patients
were classified into 4 groups based on Department of Health and Human Services
clinical treatment criteria by: CD4 and viral load, CD4 only, viral load only,
and neither.
Results: Of adolescents in care, 67% were infected
through risky behaviors; 33% were vertically infected. Adolescents infected via
risky behaviors were older and more likely to be male and black. Overall, 43% infected
via risky behaviors and 88% vertically infected were on HAART (p <0.001);
164 (36%) in the risk behaviors group and 44 (19%) in the vertically infected
group met treatment criteria by categories 1 to 3 and of those, only 84 (51%)
in the risk behaviors vs 40 (91%) in the vertically infected were on HAART (p
<0.001). There were no disparities in opportunistic infection prophylaxis
use by risk group for those with an indication. Risk behaviors had less outpatient
but similar inpatient health care utilization as vertically infected.
|
|
Infected via risky behaviors
(n = 457)
|
Vertically infected
(n = 227)
|
p value
|
|
Median age (range)
|
22 (12 to 24)
|
15 (12 to 24)
|
<0.001
|
|
% Male
|
65
|
48
|
<0.001
|
|
% Black
% Hispanic
% White
|
64
18
13
|
60
22
18
|
0.05
|
|
% Vertically infected
% Heterosexual infection
% Men who have sex with men
% Intravenous drug users
|
0
46
52
3
|
100
0
0
0
|
<0.001
|
|
Median CD4 (cells/mm3)
|
492 (0 to 1730)
|
660 (2-2200)
|
<0.001
|
|
Median viral load (copies/mL)
|
6700
(<50 to >750,000)
|
400
(<50 to >750,ooo)
|
<0.001
|
|
HAART utilization n (%)
|
195 (43%)
|
198 (88%)
|
<0.001
|
|
HAART utilization by treatment criteria
1) CD4 & viral load
2) CD4 only
3) Viral load only
4) Neither
|
45 (69%)
24 (48%)
15 (31%)
111 (38%)
|
13 (93%)
19 (95%)
8 (80%)
158 (86%)
|
|
|
Hospitalization Rate/100 person-years
|
18.6
|
17.1
|
ns
|
|
Outpatient visits per patient/year
|
4.96
|
6.97
|
<0.001
|
Conclusions: The majority of HIV-1-infected
adolescents currently in the HIVRN cohort have been infected through risky
behaviors, however, these young people were less likely to be on HAART than
their vertically infected counterparts. With the CDC recommendation of
universal testing, more HIV-infected adolescents in need of treatment will be
identified. Identifying and ameliorating patient and provider barriers to HAART
utilization is critical in this group with rising rates of infection.
|
