Antiretroviral treatment, management challenges and outcomes in perinatally HIV‐infected adolescents

Agwu, Allison L.; Fairlie, Lee

doi:10.7448/ias.16.1.18579

Cited by 171 publications

(185 citation statements)

References 76 publications

(174 reference statements)

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“…Side-effects that lead to stigmatisation, such as lipoatrophy (stavudine, zidovudine), diarrhoea and flatulence (lopinavir/ritonavir) and gynaecomastia (efavirenz), may be intolerable. [12] Failure or fear of disclosure may result in mistrust of parents and medical treatment providers. Rebellion against parents and other authority could lead to poor adherence after long periods of compliance.…”

Section: Case Vignettementioning

confidence: 99%

“…Rebellion against parents and other authority could lead to poor adherence after long periods of compliance. [12] Misinformation, lack of family support and stigmatisation from peers may further influence adherence. Mental health issues, such as depression, low self-esteem and hopelessness, and substance abuse could further influence medication compliance.…”

Section: Case Vignettementioning

confidence: 99%

“…Human papillomavirus vaccination and screening are important elements of this care. [12] HIV counselling, testing and disclosure After testing for HIV infection adolescents are less likely to link to services for prevention (barrier and hormonal contraception access, circumcision) and treatment interventions. The following groups of adolescents (key populations) are considered to be most at risk for HIV and STIs: adolescent males who have sex with men, adolescents who are sexually exploited or engage in sex work, adolescents who abuse substances, transgender adolescents (male and female), adolescents affected by AIDS (orphans, children of chronically ill caregivers), and adolescent clients of sex workers and the partners of these clients.…”

Section: Adolescence and Hiv Infectionmentioning

confidence: 99%

“…Underutilisation of HTC services results in late diagnosis and complications associated with HIV infection. [12] The support during disclosure may include healthcare providers, parents, peers and the community. Privacy, confidentiality and support to cope with negative reactions such as discrimination and alienation from family, friends and community are essential to successful HIV testing and disclosure, access to treatment, linkage and retention in care.…”

Section: Adolescence and Hiv Infectionmentioning

confidence: 99%

“…Mental health issues, such as depression, low self-esteem and hopelessness, and substance abuse could further influence medication compliance. [12] Different strategies to improve adherence include pill boxes, reminder systems (cellular telephone alarms, short messaging services (SMS)) to maintain daily schedules, peer-to-peer adherence messages and counselling together with healthcare provider and parent support. [12] Low pill burden and once-daily treatment regimens with minimal side-effects also impact on long-term compliance.…”

Section: Case Vignettementioning

confidence: 99%

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Adolescent HIV treatment issues in South Africa

Dawood

2015

S Afr Med J

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Section: Case Vignettementioning

confidence: 99%

Section: Case Vignettementioning

confidence: 99%

Section: Adolescence and Hiv Infectionmentioning

confidence: 99%

Section: Adolescence and Hiv Infectionmentioning

confidence: 99%

Section: Case Vignettementioning

confidence: 99%

See 3 more Smart Citations

Adolescent HIV treatment issues in South Africa

Dawood

2015

S Afr Med J

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Association of Risk of Viremia, Immunosuppression, Serious Clinical Events, and Mortality With Increasing Age in Perinatally Human Immunodeficiency Virus–Infected Youth

et al. 2017

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IMPORTANCE As perinatally human immunodeficiency virus-infected youth (PHIVY) in the United States grow older and more treatment experienced, clinicians need updated information about the association of age, CD4 cell count, viral load (VL), and antiretroviral (ARV) drug use with risk of opportunistic infections, key clinical events, and mortality to understand patient risks and improve care. OBJECTIVE To examine the incidence or first occurrence during follow-up of key clinical events (including Centers for Disease Control and Prevention stage B [CDC-B] and stage C [CDC-C] events) and mortality among PHIVY stratified by age, CD4 cell count, and VL and ARV status. DESIGN, SETTING, AND PARTICIPANTS Combining data from the Pediatric HIV/AIDS Cohort Study (PHACS) Adolescent Master Protocol and International Maternal Pediatric Adolescent AIDS Clinical Trials (IMPAACT) P1074 multicenter cohort studies (March 2007 through April 2015), we estimated event rates during person-time spent in key strata of age (7-12, 13-17, and 18-30 years), CD4 cell count (<200, 200-499, and Ն500/μL), and a combined measure of VL and ARV status (VL <400 or Ն400 copies/mL; ARV therapy or no ARV therapy). A total of 1562 participants in the PHACS Adolescent Master Protocol and IMPAACT P1074 were eligible, and 1446 PHIVY from 41 ambulatory sites in the 12 US states, including Puerto Rico were enrolled. The dates of analysis were March 2015 through January 2017. MAIN OUTCOMES AND MEASURES Clinical event rates stratified by person-time in age, CD4 cell count, and VL and ARV categories. RESULTS A total of 1446 PHIVY participated in the study (mean [SD] age, 14.6 [4.6] years; 759 female [52.5%]; 953 black [65.9%]). During a mean (SD) follow-up of 4.9 (1.3) years, higher incidences of CDC-B events, CDC-C events, and mortality were observed as participants aged. Older PHIVY (aged 13-17 and 18-30 years) spent more time with a VL of 400 copies/mL or more and with a CD4 cell count of less than 200/μL compared with 7-to 12-year-old participants (30% and 44% vs 22% of person-time with a VLՆ400 copies/mL; 5% and 18% vs 2% of person-time with CD4 cell count <200/μL; P < .001 for each comparison). We observed higher rates of CDC-B events, CDC-C events, bacterial infections, and mortality at lower CD4 cell counts, as expected. The mortality rate among older PHIVY was 6 to 12 times that among the general US population. Higher rates of sexually transmitted infections were also observed at lower CD4 cell counts after adjusting for age. CONCLUSIONS AND RELEVANCEOlder PHIVY were at increased risk of viremia, immunosuppression, CDC-B events, CDC-C events, and mortality. Interventions to improve ARV therapy adherence and optimize models of care for PHIVY as they age are urgently needed to improve long-term outcomes among PHIVY.

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The case for viral load testing in adolescents in resource‐limited settings

et al. 2017

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Introduction The success of HIV treatment programmes globally has resulted in children with perinatally acquired HIV reaching adolescence in large numbers. The number of adolescents living with HIV is growing further due to persisting high HIV incidence rates among adolescents in low‐ and middle‐income settings, particularly in sub‐Saharan Africa. Although expanding access to HIV viral load monitoring is necessary to achieve the 90‐90‐90 targets across the HIV care continuum, implementation is incomplete. We discuss the rationale for prioritizing viral load monitoring among adolescents and the associated challenges. Discussion Adolescents with HIV are a complex group to treat successfully due to extensive exposure to antiretroviral therapy for those with perinatally acquired HIV and the challenges in sustained medication adherence in this age group. Given the high risk of treatment failure among adolescents and the limited drug regimens available in limited resource settings, HIV viral load monitoring in adolescents could prevent unnecessary and costly switches to second‐line therapy in virologically suppressed adolescents. Because adolescents living with HIV may be heavily treatment experienced, have suboptimal treatment adherence, or may be on second or even third‐line therapy, viral load testing would allow clinicians to make informed decisions about increased counselling and support for adolescents together with the need to maintain or switch therapeutic regimens. Conclusions Given scarce resources, prioritization of viral load testing among groups with a high risk of virological failure may be required. Adolescents have disproportionately high rates of virological failure, and targeting this age group for viral load monitoring may provide valuable lessons to inform broader scale‐up.

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Antiretroviral treatment, management challenges and outcomes in perinatally HIV‐infected adolescents

Cited by 171 publications

References 76 publications

Adolescent HIV treatment issues in South Africa

Adolescent HIV treatment issues in South Africa

Association of Risk of Viremia, Immunosuppression, Serious Clinical Events, and Mortality With Increasing Age in Perinatally Human Immunodeficiency Virus–Infected Youth

The case for viral load testing in adolescents in resource‐limited settings

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