Haw Nel Jason L, Lesko Catherine R, Ng Derek K, Lam Jennifer O, Gebo Kelly, Sterling Timothy R, Rabkin Charles S, Li Jun, Buchacz Kate, Agwu Allison, Althoff Keri
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore MD USA.
Division of Research, Kaiser Permanente Northern California, Pleasanton CA USA.
Clin Infect Dis. 2025 Jun 5. doi: 10.1093/cid/ciaf300.
BACKGROUND: Little is known about the incidence of AIDS-defining conditions (ADCs) among people with perinatally acquired HIV (PHIV) who transitioned to adult HIV care in the United States and Canada. We described the incidence among PHIV and compared it with non-PHIV and across calendar era. METHODS: Using data from the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) from 2000-2022, we estimated weighted mean cumulative counts (MCC) of ADCs comparing people with PHIV and non-PHIV acquisition risk groups aged 18-40 engaged in adult HIV care. The weights accounted for differences in characteristics among HIV acquisition risk groups as well as informative censoring. We calculated 95% confidence intervals (CI) using bootstrapping. We stratified results before and after 2012, when immediate start of ART was recommended. RESULTS: There were 5,429 ADCs among 22,950 people with HIV. Among people with PHIV, the MCC of ADCs by three years in adult HIV care was 26 per 100 persons (95% CI: 15, 40) in 2000-2011 and 16 per 100 persons (95% CI: 5, 21) in 2012-2022. Within each calendar era, weighted MCCs of ADCs among people with PHIV were similar or lower than non-PHIV groups. Within each HIV acquisition risk group, weighted MCCs of ADCs were lower between 2000-2011 vs. 2012-2022. CONCLUSION: People with PHIV who transitioned to adult HIV care did not experience a greater ADC incidence than people with non-PHIV. This emphasizes the importance of continued engagement in adult HIV care, as it provides critical opportunities for ADC prevention and management.
背景：在美国和加拿大，对于那些从儿童期感染艾滋病毒（PHIV）并过渡到成人艾滋病毒护理阶段的人群中，艾滋病界定疾病（ADC）的发病率了解甚少。我们描述了PHIV人群中的发病率，并将其与非PHIV人群进行比较，以及不同日历时期的情况。 方法：利用2000年至2022年北美艾滋病队列协作研究与设计（NA - ACCORD）的数据，我们估计了参与成人艾滋病毒护理的18至40岁的PHIV人群和非PHIV感染风险组人群中ADC的加权平均累积计数（MCC）。权重考虑了艾滋病毒感染风险组之间特征的差异以及信息删失。我们使用自抽样法计算95%置信区间（CI）。我们对2012年前后（当时建议立即开始抗逆转录病毒治疗）的结果进行了分层。 结果：在22950名艾滋病毒感染者中发生了5429例ADC。在PHIV人群中，2000 - 2011年成人艾滋病毒护理三年期间ADC的MCC为每100人26例（95%CI：15，40），2012 - 2022年为每100人16例（95%CI：5，21）。在每个日历时期内，PHIV人群中ADC的加权MCC与非PHIV组相似或更低。在每个艾滋病毒感染风险组内，2000 - 2011年与2012 - 2022年相比，ADC的加权MCC更低。 结论：过渡到成人艾滋病毒护理阶段的PHIV人群，其ADC发病率并不高于非PHIV人群。这强调了持续参与成人艾滋病毒护理的重要性，因为这为ADC的预防和管理提供了关键机会。
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