The Centers for Disease Control and Prevention estimates that in 2016, there were 11,915 persons with perinatally-acquired HIV (PHIV) in the U.S., including 10,101 adolescents and young adults. Globally, 1.7 million children under the age of 15 are living with HIV and with effective antiretroviral medications (ARVs) are expected to survive into adolescence, young adulthood and beyond. The Adolescent Master Protocol (AMP) was designed to evaluate long-term effects of HIV infection and ARVs on multiple domains. AMP enrolled 451 children with PHIV between ages 7-16 years and 227 children living with perinatal HIV exposure but uninfected (PHEU) from 2007-09. The AMP Up and AMP Up Lite studies (AMP Up Series) were developed to allow for continued follow-up of young adults with PHIV (YAPHIV) beyond 18 years of age, including AMP participants, to assess physical and mental health as they transition to adulthood. These innovative studies share similar objectives and are designed to facilitate long- term follow-up with annual online and medical chart abstracted data collection. AMP has been highly productive with numerous influential publications. AMP Up has yielded important information ? including the role of social support and ability to self-manage health care on a successful transition to adult clinical care, and the high risk of postpartum viremia and early HPV-associated cervical lesions. Yet the long-term effects of HIV and ARV on health in young adulthood are still unfolding. The comprehensive data collected since early childhood on a substantial subset of AMP Up participants previously in AMP provides the invaluable opportunity to assess how early HIV and ARV, mental health, neurocognitive function, and family dynamics impact adult outcomes.
The specific aims of the AMP Up Series are to: 1. Define the impact of PHIV infection, ARVs, and individual, social and structural factors on: the transition to adulthood and adult care; brain structure and neurological functioning; academic, vocational, emotional and social functioning; mental health; medication and health care adherence; sexual behaviors; and substance use. 2. Identify infectious and non-infectious complications of HIV and their associations with ARVs and HIV. 3. Investigate genetic, epigenetic, virologic, inflammatory, and immunologic factors which impact the course of HIV infection, its complications, the response to treatment, and potential for HIV remission/cure.
The PHACS (Pediatric HIV/AIDS Cohort Study) Adolescent Master Protocol (AMP) Up Series (AMP Up Series) of studies ? AMP Up and AMP Up Lite ? are following a cohort of young adults with perinatal HIV (YAPHIV) and a comparison group of young adults with perinatal HIV exposure who are uninfected, a substantial proportion of whom have longitudinal data since early childhood on HIV status, antiretroviral medications, and clinical outcomes. Their primary goal is to evaluate the impact of HIV disease and its treatment on health and behavior outcomes across a wide range of domains, including cardiopulmonary, metabolic, mental health, neurological, neurocognitive, oral, reproductive, substance use and sexual behaviors, emotional, social and academic functioning, and health care utilization and access. This proposal describes our strategy for continued follow-up of these young adults to inform research and interventions for YAPHIV worldwide.
