Lower probability of viral suppression in people living with HIV who are parents in Lima, Peru

Abstract

AbstractIntroductionParenting can be a detriment for selfcare among people living with HIV (PLWH) out of concern for their children’s futures and responsibilities that may limit attendance to health services. We explored the association between having children <20 years-old and viral suppression in PLWH.MethodsRetrospective cohort study from secondary data of PLWH enrolled at the largest HIV program in Lima between 2012-2018. We established parenthood by participant self-report children <20 years-old at enrollment, with additional data gathered for PLWH who reported a child born during the first year after enrollment. The main outcome was viral suppression (<400 copies/mL) by the end of follow-up. We conducted Cox regression analyses for repeated events, censoring at time of death or lost to follow-up. We built the final model by backward stepwise regression including potentially important variables and those with p-value ≤ 0.20 in bivariate analyses, presenting hazard ratios (HR), adjusted HR (aHR), and 95% confidence intervals (CIs).ResultsIn 3170 PLWH, median age at enrollment was 31.6 years (range 17.9-76.1), 79.8% were men and 27.2% reported having children <20 years-old (median=2). At end of follow-up (8766.6 person-years), 534 (62.0%) were virally suppressed. In our final multivariate model, having children <20 years-old (aHR 3.53; [95% CI] 1.88 - 6.62) and the birth of a child during the first year after enrollment in the program (HR 1.81; [95% CI] 1.30 – 2.50) were independently associated with lack of viral suppression by end of follow-up. Based on health status of the PLWH, we estimated 70% and 69% of children to be at risk of maternal and paternal orphanhood, respectively.ConclusionIn our setting, being a parent was associated with lower probability of viral suppression, creating a risk of orphanhood for children of PLWH. Family support services may facilitate HIV care and help PLWH maximize viral suppression.