Children, Adolescents With HIV Are Achieving Viral Suppression at a Lower Rate Than Adults

Children and adolescents with HIV are not achieving viral suppression, as defined by the UNAIDS’s 95-95-95 goals, as quickly as adults, according to a new review.

The researchers conducted a retrospective cohort study to assess the proportions of children, adolescents, and adults with HIV viral suppression at 1, 2, and 3 years after initiating antiretroviral therapy (ART).

Data from the International Epidemiology Databases to Evaluate AIDS (IeDEA) consortium was used to identify patients with HIV initiating ART between January 1, 2010, and December 31, 2019. Nearly 278,000 patients from 148 sites in 31 countries were included in the analysis.

Using an intention-to-treat approach, the researchers found that 36% of children and adolescents were virally suppressed at 1 year post-ART initiation, 30% were virally suppressed at 2 years post-initiation, and 24% were virally suppressed at 3 years post-initiation. In comparison, 44% of adults were virally suppressed at year 1, 36% were virally suppressed at year 2, and 29% were virally suppressed at year 3.

The results were then adjusted for the following factors: missing viral load measurements among those who transferred, were lost to follow-up, or who were in follow-up without viral load testing. The analysis after adjusting for these factors showed that 64% of children and adolescents were virally suppressed at year 1, 62% were virally suppressed at year 2, and 59% were suppressed at year 3. For adults, 79% were virally suppressed at year 1, 72% were virally suppressed at year 2, and 65% were virally suppressed at year 3.

“Although adults with HIV are approaching the global target of 95% viral suppression, progress among children and adolescents is much slower,” the researchers concluded. “Substantial efforts are still needed to reach the viral suppression target for children and adolescents.”

—Amanda Balbi

Reference

Han WM, Law MG, Egger M, et al. Global estimates of viral suppression in children and adolescents and adults on antiretroviral therapy adjusted for missing viral load measurements: a multiregional, retrospective cohort study in 31 countries. Lancet HIV. 2021;8(12):e766-e775. https://doi.org/10.1016/s2352-3018(21)00265-4