Aging of adult lifetime survivors with perinatal HIV

We describe the emerging clinical outcomes for adults born with perinatally acquired HIV (PHIV), who have been living with HIV throughout their life. Whilst many comorbidities appear similar to adults with horizontally acquired HIV, they manifest at a younger chronological age. The additional impact of HIV throughout postnatal, childhood and adolescent growth and development requires further consideration.

There is growing evidence of an increased incidence of metabolic, cardiovascular, respiratory, bone and renal impairment as well as structural brain changes associated with impaired cognitive function, and mental health disorders; early case series data suggests a six-fold increased prevalence of psychosis for those with lifelong HIV compared with age-matched peers. Older age, prior CDC-C diagnoses and lower nadir CD4 count confer the greatest risk of PHIV complications in adulthood, but biological factors are compounded by socioeconomic deprivation, bereavement, HIV-associated stigma, discrimination and immigration. The aetiology of these increased comorbidities is yet to be fully elucidated but includes lifelong systemic inflammation and immune dysfunction despite suppressive antiretroviral therapy (ART).

Adults living with lifelong HIV experience increased risk of comorbidities at a younger chronological age despite viral suppression on ART. Exploring the aetiology and characterizing the clinical manifestations of lifelong HIV can best inform screening tools and interventions that can enhance quality of life and longevity.