Increasing the life expectancy of young people living with HIV requires more than just adhering to care regimens, researchers say

Life expectancy for young people living with HIV is expected to be 10.4 years shorter in men and 11.8 years shorter in women compared to individuals without HIV, according to a study by researchers at Massachusetts General Hospital (MGH), one of the founders of the Mass General Brigham health care system. , has found.

The researchpublished in JAMA Health Forumalso reported that careful adherence to HIV care throughout the individual’s lifespan can lead to important gains in life expectancy, and that for some adolescents with HIV, interventions targeting structural and social factors such as poverty and housing could also lead to improvements to lead.

“The U.S. has made tremendous progress toward ending the HIV epidemic in recent years, and our research has shown that HIV care works especially well when individuals have access to timely treatment and can stay on it throughout their lives remain,” said lead author Anne Neilan, MD. MPH, a physician-researcher in the Division of Infectious Diseases at Massachusetts General Hospital.

“Especially for youth who acquired HIV in adolescence, the lower life expectancy seen with HIV may be more related to causes of death other than HIV itself because current treatment is so effective.”

Nearly 46,000 people in the U.S. ages 13 to 24 are living with HIV, which can damage the immune system, making the body more susceptible to infections and some cancers.

In their study, MGH researchers looked at two youth cohorts: one who contracted HIV around birth (perinatally); and the other who acquired HIV during adolescence (non-perinatally).

They used mathematical simulation models and US national clinical data on adolescents to show that youth with HIV acquired at birth were expected to suffer a life expectancy loss of 10.4 years (for boys and young men) and 11.8 years (for girls and young women) compared to young people. without HIV.

The loss of life expectancy was even greater for youth with HIV acquired in adolescence: 15.0 years for boys and young men, and 19.5 years for girls and young women.

The study also found that under ideal HIV care, loss of life expectancy would be expected to improve substantially for young people with HIV acquired at birth (0.5 years for boys and young men, and 0.6 years for girls and young women). .

With ideal care for youth with HIV acquired in adolescence, life expectancy loss also improved, but not as much with continued project losses of 6.0 years (for boys and young men) and 10.4 years (for girls and young women) .

“Especially for youth who acquired HIV at birth, their projected life expectancy comparable to that of youth without HIV in an ideal care scenario illustrates the importance of lifelong antiretroviral therapy and care engagement,” notes Neilan.

“For the group who acquired HIV during adolescence, we predicted a significant gap in life expectancy compared to their counterparts who had HIV at birth, even after ideal HIV care,” she says.

“We believe that this difference is not due to HIV itself, but rather to systemic, social and behavioral factors, and that these must be addressed to improve life expectancy for this higher risk group.”

These factors include poverty, housing, the right to insurance, transportation, fragmentation of the health care system and HIV stigma, the researcher explains.

“Life expectancy is an important health indicator for the population,” Neilan emphasizes, “and our study underlines the significant work that needs to be done in HIV care and treatment for adolescents living with HIV if they are to benefit in the same way as adults of the striking consequences of the disease. progress in recent years in the diagnosis and treatment of HIV.”