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|Title:||Changing Trends in Complications and Mortality among US Youth and Young Adults with HIV Infection in the Era of Combination Antiretroviral Therapy|
|Authors:||Mirani, Gayatri;Williams, Paige L.;Chernoff, Miriam;Abzug, Mark J.;Levin, Myron J.;Seage, George R.;Oleske, James M.;Purswani, Murli U.;Hazra, Rohan;Traite, Shirley;Zimmer, Bonnie;Van Dyke, Russell B.|
|Keywords:||13;2012;24-year-old children and;an estimated 40 000;at the end of;Human;immunode fi ciency virus;Mortality;opportunistic infections;pediatric hiv;Pregnancy;psychiatric;states were infected with;youth in the united|
|Abstract:||BACKGROUND: Combination antiretroviral therapy (cART) has resulted in a dramatic decrease in HIV-related opportunistic infections and deaths in US youth, but both continue to occur. METHODS: We estimated the incidence of complications and deaths in IMPAACT P1074, a long-term US-based prospective multicenter cohort study conducted from April 2008 to June 2014. Incidence rates of selected diagnoses and trends over time were compared to those from a previous observational cohort study, P219C (2004-2007). Causes of death and relevant demographic and clinical features were reviewed. RESULTS: Among 1201 HIV-infected youth in P1074 (87% perinatally-infected; mean age of 20.9 (±5.4) years at last chart review), psychiatric and neurodevelopmental disorders, asthma, pneumonia, and genital tract infections were among the most common comorbidities. Compared to P219C, conditions with significantly increased incidence included substance or alcohol abuse, latent tuberculosis, diabetes mellitus, atypical mycobacterial infections, vitamin D deficiency or metabolic bone disorders, anxiety disorders and fractures; while the incidence of pneumonia significantly decreased. Twenty-eight deaths occurred, yielding a standardized mortality rate 31.5 times that of the US population. Those who died were older, less likely to be on cART, and had lower CD4 counts and higher viral loads. Most deaths (86%) were due to HIV-related medical conditions. CONCLUSIONS: Opportunistic infections and deaths are less common among HIV-infected youth in the US in the cART era, but the mortality rate remains elevated. Deaths were associated with poor HIV control and older age. Emerging complications such as psychiatric, inflammatory, metabolic and genital tract diseases need to be addressed.|
|More Information:||Volume : 61Start page : civ687|
END PAGES : civ687
|Appears in Collections:||Clinical Infectious Diseases|
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