Improving life expectancy for youth with HIV in U.S.

Illustration of individuals with red HIV/AIDS ribbons on their shirts

July 3, 2024— While life expectancy remains lower among youth with HIV compared to their peers without HIV, these gaps have less to do with the disease itself and more to do with disengagement from care and other sociodemographic factors that impact life expectancy, according to a new study co-authored by Harvard T.H. Chan School of Public Health’s Kunjal Patel.

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

Improvements in HIV care have resulted in longer life expectancies for adults with the disease, but little has been known about survival estimates for youth. Additionally, no previous studies have explored if the benefits of better treatment extend equally to or are different between adolescents with perinatal HIV, or PHIV (HIV acquired at or around the time of birth), and non-perinatal HIV, or NPHIV (HIV acquired at a later point in life).

To learn more, the researchers developed a microsimulation model to project the life expectancies of U.S. 18-year-olds with PHIV, NPHIV, and without HIV. They ran the model to account for typical HIV treatment and care engagement—which is imperfect—and typical disease progression. They then ran the model as if youth perfectly adhered to treatment and never fell out of care.

The study found that youth with HIV had shorter projected lifespans than youth without HIV with typical HIV care engagement. This gap in life expectancy is larger than that seen between adults with and without HIV. Importantly, the gap narrowed substantially when the researchers modeled an “ideal” care scenario, particularly for youth with PHIV. For youth with NPHIV, the gap persisted.

According to the researchers, the persistent gap in life expectancy faced by youth with NPHIV is attributable not just to the disease itself, but to systemic barriers such as poverty, housing, insurance eligibility, transportation, 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 wrote. “To improve life expectancy for youth with NPHIV, in addition to optimizing HIV care, it will be necessary to identify interventions that address…structural and social factors.”

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