{"doi":"10.1093/ofid/ofaf624","title":"Long-Term Outcomes of Young Adults With Perinatal Human Immunodeficiency Virus (HIV) Infection in the United States and Puerto Rico","abstract":"Abstract Background Data on mortality, clinical events, viral load (VL), and immunosuppression among young adults aging with perinatally acquired human immunodeficiency virus (YAPHIV) are limited. Methods Among YAPHIV ≥ 18 years in the Pediatric HIV/AIDS Cohort Study, we calculated incident mortality, CDC-C/WHO-4 rates, and proportion of person-years (PY) with elevated VL (≥200 copies/mL) and immunosuppression (CD4 < 200 cells/mm3) by age strata 18–21, 22–25, 26–29, and ≥30 years. We compared mortality rates to the US population and identified predictors of mortality/CDC-C/WHO-4 events at age ≥ 25 years. Results Six hundred seventeen participants had median follow-up of 6.5 years; at baseline, 63% were 18–21 years, 61% were female, 63% self-reported as Black, median CD4 count was 561 cells/mm3, and 66% had VL < 200 copies/mL. Mortality was highest at ≥30 years (8.1 per 1000PY [95% CI: 3.0, 22.0]). Black YAPHIV had mortality rates at least 7.1 (3.0, 17.1) times higher than white non-Hispanic persons in the US population. Proportion of elevated VL person-time decreased while low CD4 person-time increased as participants aged. Among 307 participants followed after age ≥ 25 years, elevated VL, low CD4, and prior CDC-C/WHO-4 event strongly predicted risk of incident mortality/CDC-C/WHO-4 event (C-index: 0.94); risk at 3 years of follow-up was 19% (0%, 45%) among those with all 3 characteristics. Other important predictors were poor treatment adherence, current cannabis use, lack of current employment/education, and stressful events (C-index: 0.81). Conclusions There is excess mortality with age for YAPHIV, particularly for Black YAPHIV. Interdisciplinary interventions are needed to improve treatment outcomes for YAPHIV at highest identified risk.","journal":"Open Forum Infectious Diseases","year":2025,"id":577535,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":0.0,"corpus_rank":10062,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":true,"is_dataset_confidence":0.5622,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":920185,"name":"Alicia Jaramillo-Underwood","orcid":null,"position":1,"is_corresponding":false},{"id":382511,"name":"Kunjal Patel","orcid":"0000-0003-0002-681X","position":2,"is_corresponding":false},{"id":435842,"name":"Sean S. 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