Key Findings to Date
PHACS has identified health issues associated with perinatal (in the womb) exposure to HIV, as well as positive health outcomes of ART. So far, SMARTT and the AMP Up Series have provided and continue to provide important information. These include long-term health outcomes of perinatal HIV infection and exposure. The effort to increase knowledge continues with our current protocols. The aim of these studies is to evaluate better HIV treatments, more targeted prevention efforts for negative health outcomes, and more timely HIV care.
Key findings about physical health:
- Perinatally HIV-infected children and adolescents born more recently (1994–2002) had higher CD4 counts (signifying a healthier immune system) and better HIV control than those born earlier (1991–1993).
- Among perinatally HIV-infected youth, 15% had insulin resistance, although it may be linked to obesity more than to ART and HIV. With insulin resistance, the body makes insulin but does not use it effectively. As a result, glucose builds up in the blood, leading to type 2 diabetes or pre-diabetes.
- Asthma and atopic dermatitis (a skin condition also called eczema) are more common in perinatally HIV-infected children and adolescents compared to perinatally HIV-exposed but uninfected children and adolescents.
- Compared to children from the general population, hearing loss is more common in children who were exposed perinatally to HIV.
- Combination ART protects against heart problems in perinatally HIV-infected youth.
- Both HIV-exposed but uninfected and HIV-infected youth have high risk of language impairment. However, more recent research indicates that the risk is not associated with the antiretroviral therapy. Children exposed to HIV in the womb and whose mothers received combinations of anti-HIV drugs during pregnancy were no more likely to have language delays than were children exposed to HIV in the womb and whose mothers did not receive these recommended treatments.
- Perinatally HIV-infected youth enter puberty slightly later compared to perinatally HIV-exposed but uninfected youth. However, it seems that current ART treatment, as opposed to what was in use from 1991–1993, may result in more normal timing of puberty.
- Both HIV-exposed but uninfected children and adolescents had a higher rate of mental health problems than did HIV-infected children and adolescents.
Key findings about behavioral health among study participants:
- Among sexually active, perinatally HIV-infected youth, 62% reported having unprotected sex. Among those who had unprotected sex, 42% had detectable levels of HIV in their blood. Among the youth with detectable levels of HIV, 22% had a form of the virus that was resistant to multiple classes of AIDS drugs.
- Among a subset of sexually active, perinatally HIV-infected youth, roughly 20% reported that they did not know their HIV status the first time they had sexual intercourse.
- Illicit substance use during pregnancy among HIV-infected women was low and was substantially less than the women in earlier studies.
Key findings about HIV treatments:
- One such study found that the antiretroviral drug tenofovir was used by almost 40% of HIV-infected women during pregnancy. (The use of tenofovir continues to increase and is now about 60%.)