Human Immunodeficiency Virus

Human immunodeficiency virus (HIV) is a nononcogenic virus of the Retroviridae family and consists of two types, HIV-1 and HIV-2 (with HIV-1 predominating in the Western world). HIV-related immunodeficiency occurs through the invasion and destruction of CD4+ lymphocytes, affecting both humoral and mucosal immunity. By surviving in resting T cells and other reservoirs, HIV has a period of clinical latency which is responsible for the chronic nature of the disease and the need for lifelong antiretroviral therapy (ART) for viral suppression and disease control. Epidemiologic data from year-end 2019 estimate that nearly 1.2 million people aged 13 and older are living with diagnosed HIV in the United States with the highest prevalence in the South and Northeast [1]. Due to the success of ART, people with HIV (PWH) are living longer and healthier lives, and those who acquired HIV either perinatally or through sexual activity during adolescence are increasingly transitioning to adult care, increasing the generalist’s exposure to young adults with HIV. In addition, adult generalists are likely to encounter youth and young adults with HIV (YAWH) who have been recently diagnosed. Although the largest percentage of PWH are aged 55–59 (15%), the rate of new HIV infection by age at diagnosis is highest in the 25–29-year-old group (rate 31.1/100,000 population), followed by persons aged 20–24 years (27.3/100,000 population). Thus, adult generalists need to understand the specific challenges for all YAWH, including young adults with newly diagnosed HIV and those with perinatal HIV aging out of pediatric care.