Health

Enhancing Life Expectancy for Youth Living with HIV in the U.S.

While life expectancy remains lower among youth with HIV, these gaps have less to do with the disease itself and more to do with disengagement from care and other sociodemographic factors, according to a new study co-authored by Harvard Chan School’s Kunjal Patel.

July 3, 2024— Despite advancements in HIV care, youth with HIV still have a lower life expectancy compared to their peers without the virus. However, a new study co-authored by Kunjal Patel from the Harvard T.H. Chan School of Public Health suggests that this disparity is more influenced by disengagement from care and various sociodemographic factors rather than the disease itself.

The study, published on May 10 in JAMA Health Forum, was led by Patel, a senior research scientist in the Department of Epidemiology.

While improvements in HIV treatment have extended the life expectancy of adults with HIV, there has been limited data on survival estimates for youth. Moreover, no prior research has examined whether these benefits are equally distributed between adolescents with perinatal HIV (PHIV) and those with non-perinatal HIV (NPHIV).

To address this gap, the researchers created a microsimulation model to project the life expectancies of 18-year-olds in the U.S. with PHIV, NPHIV, and without HIV. The model considered typical HIV treatment and care engagement, which is often inconsistent, as well as typical disease progression. They also simulated an “ideal” scenario where youth perfectly adhered to treatment and remained consistently engaged in care.

The findings revealed that youth with HIV have shorter projected lifespans compared to their HIV-negative peers under typical care conditions. This life expectancy gap is more pronounced than that observed between adults with and without HIV. However, when the researchers modeled an ideal care scenario, the gap significantly narrowed, especially for youth with PHIV. For those with NPHIV, the gap remained.

The researchers attributed the persistent life expectancy gap for youth with NPHIV not only to the disease but also to systemic barriers such as poverty, housing instability, insurance issues, transportation challenges, health system fragmentation, and stigma.

“For youth with PHIV, there may be opportunities to close the life expectancy gap by improving HIV treatment adherence and retention in care,” they noted. “To improve life expectancy for youth with NPHIV, it will be necessary to identify interventions that address structural and social factors in addition to optimizing HIV care.”

Read the study: Projected Life Expectancy for Adolescents With HIV in the US

Read a press release from Massachusetts General Hospital: Increasing Life Expectancy for Youth with HIV Requires More Than Just Adherence to Care Regimens

Image: iStock / Red Diamond

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