Socioeconomic Outcomes of Adults with Perinatally Acquired Human Immunodeficiency Virus (HIV) Compared to Their Siblings Without HIV: A Nationwide Cohort Study from the Netherlands

Abstract

Background With effective antiretroviral treatment, more children with perinatally acquired human immunodeficiency virus (HIV) reach adulthood. We assessed their long-term socioeconomic outcomes - educational level, reliance on social welfare or absence of income, and living in poverty - using a sibling comparison design to disentangle biological from familial and environmental influences. Methods We conducted a retrospective cohort study from the Netherlands using data from the ATHENA cohort and nonpublic microdata from Statistics Netherlands (CBS). We included individuals aged ≥18 years with perinatally acquired HIV and siblings without HIV (identified through maternal CBS data). Logistic regression evaluated associations between sociodemographic and HIV-related factors with outcomes. Generalized estimating equations assessed differences between groups. Results Among 145 individuals with HIV, 12% had low educational level, 17% relied on social welfare or had no income, and 15% lived in poverty. Receiving HIV care before 1996 was associated with low educational level (odds ratio [OR], 4.58 [95% confidence interval {CI}, 1.46-14.43]; P =. 01), while older age increased odds of having no income or reliance on social welfare (OR, 1.24/year [95% CI, 1.10-1.39]; P =. 0001). Older age at HIV diagnosis was linked to living in poverty (OR, 1.20/year [95% CI, 1.06-1.34]; P =. 003). Compared to 94 siblings, individuals with HIV had higher odds of low education (adjusted OR [aOR], 6.59 [95% CI, 1.91-22.73]; P <. 01) and having no income or social welfare reliance (aOR, 2.54 [95% CI, 1.05-6.12]; P =. 04). Poverty rates did not differ significantly between groups. Conclusions Adults with perinatally acquired HIV face educational and economic disadvantages compared to their siblings without HIV, highlighting the lasting impact of perinatal HIV beyond familial or environmental background.