Dr Allison Agwu: We Must Not Forget About Adults Living With HIV for Decades

Adults living with HIV is a population that sometimes gets lost—even though some people born with HIV have now been living with the virus for 30 or 40 years. There needs to be research on the implications of long-standing antiretroviral treatment on all aspects of these patients' lives to better understand how to optimize their outcomes, noted Allison Agwu, MD, ScM, FAAP, FIDSA, professor of pediatrics and internal medicine, Division of Infectious Diseases; program director, Pediatric Adolescent Young Adult HIV/AIDS Program; and medical director, Accessing Care Early Clinic at the Johns Hopkins University School of Medicine.

Agwu presented her talk, "What Lifelong Really Means: Adults Born With HIV," today during IAS 2021, this year's virtual annual meeting of the International AIDS Society, taking place July 18-21.

Transcript

Can you tell us about yourself and your work?

I'm Dr. Allison Agwu. I am both an adult and pediatric infectious diseases clinician and researcher. I'm at Johns Hopkins in Baltimore. I do straddle the divide. I'm a professor of medicine and pediatrics, with a focus on infectious diseases and specifically HIV.

In terms of what I do, I really do wear a lot of hats. I am the director of the Pediatric Adolescent HIV/AIDS Program, which is a program that takes care of patients from 0 to 25 years—so we'll see a population of adolescents and young adults. And I also medically direct the youth transition clinic into the adult space, which is the Accessing Care Early Clinic, which helps to transition peds kids from adolescent to adult spaces and all into adulthood, where we have our aging perinatal population and individuals who acquired HIV early. That's my clinical work.

My research really does focus on optimizing outcomes, particularly for young people with HIV. Some prevention work, but a lot of treatments and how to best care for that population in terms of management strategies, but also the right medicines, the right team, how to best optimize their care and outcomes.

Tell us about your talk from IAS 2021, “What Lifelong Really Means: Adults Born With HIV.”

It’s really awesome that you picked up on this as something you'd want to focus on. As I mentioned, I do live and work in a space where I take care of a lot of young people who were born with HIV. And I think critically important to mention is that when these young people were born and growing up, it wasn't though they were going to survive, right? And so the fact that we're even talking about adults born with HIV, many who are in their 30s and some approaching 40, is amazing.

The talk focused on this population, who sometimes gets lost. There are about 12,000 of them in the US, in terms of people born with HIV, and about 50% of them are over 25. So they're aging, and—I have to be careful, because I'm getting older—they're getting older, and oftentimes they can be lost in translation. What I mean by that is, pediatric clinics think about them, adult clinics, the large majority of individuals [acquired HIV] through same gender–loving behavior or injecting drugs, etc. And then oftentimes they are lumped in this unknown category, and we aren't really following them and seeing them.

And so the talk focused on what we know, based on data in adolescents, and saying we know in adolescents, there are some cohorts looking at those born with HIV,and what we see, and then there are some cohorts of adults who are not born with HIV, but adults who have had HIV for 30, 40 years—50% of adults living with HIV are over the age of 50 and may have been living with HIV for 30 years—and saying, we have these people with long-standing HIV who are adults and first we've seen these comorbidities, and then we have these young people where we're seeing some things happen. But we're not looking at these adults born with HIV who have now been living with HIV for 30 or 40 years.

What are the implications of long-standing HIV, long-standing antiretroviral treatment on all aspects of their life. Not just their bodies, but their brains, their employment, sort of the whole 360 degrees, and how we need to look at them to optimize their outcomes.