Clinical and immunovirological status in children, adolescents and young adults with early-life-acquired HIV: a Spanish multi-cohort analysis since 2020

Abstract

OBJECTIVES: ART has significantly improved survival among children, adolescents and young adults who acquired HIV perinatally or during early childhood (early-life acquired HIV, ELHIV). However, challenges persist, including virological failure (VF) and suboptimal immune recovery. This study aimed to describe clinical, virological and immunological outcomes of ELHIV individuals in Spain since 2020, and to identify factors associated with VF and impaired immune recovery. METHODS: A multicentre, retrospective cohort study was conducted using data from 642 ELHIV individuals actively followed in the CoRISpe and CoRISpe-FARO cohorts. Data included demographics, ART history, virological suppression (viral load ?50 copies/mL), CD4/CD8 ratio and CDC immunological categories. Logistic regression identified factors influencing VF and immune progression. RESULTS: The median age of participants was 24 years, with 67.6% aged ?18. Most (93.6%) acquired HIV via vertical transmission, with ART initiated at a median age of 1.93 years. At the time of analysis, 99.1% were on ART. Although 81.1% achieved virological suppression, 10.5% experienced VF, associated with PI-based regimens, independent of age, and a lower CD4 nadir. Immune recovery, defined as a CD4/CD8 ratio ?1, was achieved by 52.3%. Impaired recovery was linked to older age at ART initiation and lower CD4 nadir, particularly among adolescents (12-18 years) and young adults. Children (<12 years) showed better immune profiles, with 97.8% achieving CD4 counts ?500 cells/mm³. CONCLUSIONS: Early ART initiation and tailored interventions are essential to optimize outcomes in ELHIV populations. PI-based regimens were a risk factor for VF, whereas integrase strand transfer inhibitors appeared protective. Adolescents and young adults require targeted support to improve adherence and immune recovery, aligning with UNAIDS goals.