Characteristics and outcomes of adolescents living with perinatally acquired HIV within Southern Africa.

BACKGROUND Using data from 15 International epidemiology Databases to Evaluate AIDS in Southern Africa (IeDEA-SA) sites, we compared the characteristics and outcomes of adolescents living with perinatally acquired HIV (ALPH). METHODS We included ALPH entering care aged <13 years with ≥1 HIV care visit during adolescence (10-19 years). We compared the characteristics and cross-sectional outcomes: transfer out, loss to follow-up (LTFU: no visit in the 12 months prior to database closure), mortality, and retention between those who entered care aged <10 vs. aged 10-13 years; and explored predictors of mortality after age 13 years using Cox Proportional Hazards models. RESULTS Overall, 16,229 (50% female) ALPH who entered HIV care aged <10 years and 8897 (54% female) aged 10-13 years were included and followed for 152,574 person-years. During follow-up, 94.1% initiated ART, with those who entered care aged <10 more likely to have initiated ART (97.9%, 95% CI 97.6;98.1%) than those who presented aged 10-13 years (87.3%, 95% CI 88.6;88.0%). At the end of follow-up, 3% had died (entered care aged <10 vs. 10-13 years; 1.4% vs. 5.1%), 22% were LTFU (16.2% vs. 33.4%), and 59% (66.4% vs. 45.4%) were retained. There was no difference in the risk of dying after the age of 13 years between adolescents entering care aged <10 vs. 10-13 years (adjusted hazard ratio 0.72; 95% CI 0.36;1.42). CONCLUSION Retention outcomes for ALPH progressively worsened with increasing age, with these outcomes substantially worse among adolescents entering HIV care aged 10-13 vs. <10 years.