Younger patients, aged 13-25 years, face a qualitatively different set of complex social, psychological, and medical challenges, compared to older patients starting ART but the majority of clinical research has focused on persons in the middle years of life. We sought to understand how the predictors of virologic suppression differ in younger versus older naïve patients.
HIV+ individuals initiating ART between 1/1/2007 and 3/31/2015 were identified from OPERA, a collaboration of HIV caregivers from 79 clinics in 15 states. Virologic success was defined as HIV RNA <50 copies/mL. Patients were followed from ART initiation to the first of: an HIV RNA <50 copies/mL, discontinuation of regimen, loss to follow up, or death. Predictors of suppression were evaluated using Cox proportional hazards models.
Out of 9,190 HIV+ naïve patients 1,877 were aged 13-25 years and 6,139 were aged 26-49 years. Patients aged 50+ were not included. Younger patients were largely in their 20s (median 23.2, IQR 21.5, 24.7) and as compared to middle-aged patients (aged 36.4, IQR 30.6, 42.8); were more likely to be male (91.6% vs 85.8%); African American (50.3% vs 34.6%); and MSM (69.6% vs 57.7%) all at p < 0.0001. At baseline, younger patients had lower VL, higher CD4 counts, and were much less likely (vs. middle aged) to initiate ART with AIDS or HCV and were more likely to start therapy after 2011 (71% vs 56.5%) with an INSTI regimen (35.2% vs 28.2%). Syphilis was highly prevalent in both groups (25.0% vs 26.7%). Figure 1 depicts the predictors associated with suppression. The strongest predictor of suppression in 13-25 (HR 2.0; CI 1.6, 2.5) and 26-49 (HR 2.4 CI 2.2, 2.6) age groups was initiating on an INSTI based regimen. While HCV coinfection was associated with a significantly (p=0.02) lower probability of suppression among 26-49 year olds, it was not significant among those aged 13-25 (p=0.06)
While younger and middle-aged patients differ substantially in baseline characteristics, they share similar predictors for virologic success. Early initiation and use of INSTI containing regimens are the most important factors for achieving suppression. HIV prevention targeting young MSM of color is needed to decrease new infections in this vulnerable group.
C. Henegar, ViiV Healthcare: Research Contractor , Research support
S. Zelt, Viiv Healthcare: Employee , Salary and Stock options
J. Fusco, ViiV Healthcare: Research Contractor , Research support
K. Schulman, ViiV Healthcare: Consultant and Research Contractor , Consulting fee and Research grant
R. D' Amico, ViiV Healthcare: Employee , Salary and stock options
M. Wohlfeiler, ViiV Healthcare: Investigator and Scientific Advisor , Consulting fee and Research grant
Gilead Sciences: Investigator and Speaker's Bureau , Research grant and Speaker honorarium
Serono: Speaker's Bureau , Speaker honorarium