Brief Report: Youth Who Acquired HIV Perinatally Have Poorer Viral Suppression Than Those Who Acquired HIV Later in Life: Findings From a Population Survey in Zimbabwe.

BACKGROUND

Perinatally acquired HIV may lead to worse health outcomes than later acquisition. We compared the demographic and clinical characteristics of youth diagnosed with HIV in childhood and adulthood, as a proxy for acquisition route (perinatal vs. horizontal).

SETTING

Youth aged 18-24 years in 3 provinces in Zimbabwe were included.

METHODS

In a representative population-based survey, participants were asked their HIV status, date of HIV diagnosis if positive, and whether they were diagnosed in childhood. A dried blood spot was taken to measure viral load. Multilevel mixed-effects generalized linear modelling was used to estimate the association between HIV acquisition time and viral nonsuppression (≥1000 copies/mL).

RESULTS

A total of 17,682 participants (60.8% female) were enrolled, 17,553 (99.3%) gave a dried blood spot sample, 1200 (6.8%) tested HIV antibody-positive (7 indeterminate results), and 26 reported being HIV-positive without confirmation. Of the 1226 participants living with HIV, 435 (35.5%) self-reported that they were HIV-positive, of whom 196 (45.1%) were diagnosed in childhood (median age 7 years). A higher proportion of adult-diagnosed than child-diagnosed participants were female (91.2% vs. 76.5%), had ever had sex (93.3% vs. 61.5%), had been married/cohabiting (59.4% vs. 19.4%), and had been pregnant (78.9% of women vs. 40.0%). A lower proportion had viral suppression (39.3% vs. 52.5%). Adjusting for sex, age, marital status, and education, those diagnosed in childhood had higher odds of viral nonsuppression (adjusted odds ratio = 1.83, 95% confidence interval: 1.17 to 2.85, P = 0.008).

CONCLUSIONS

Youth who acquired HIV perinatally have differentiated care needs and greater risk of viral nonsuppression compared with those who acquired HIV later.