Optimizing antiretroviral therapy in adolescents with perinatally acquired HIV-1 infection

Foster, Caroline; Fidler, Sarah

doi:10.1586/eri.10.129

Cited by 34 publications

(26 citation statements)

References 107 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This result may be a reflection of the challenges of retaining adolescents in care. 21 It is also possible that there was “treatment fatigue” and that parents or guardians stopped therapy in apparently healthy HIV-infected children. The literature for Latin America and the Caribbean suggests many causes for non-adherence, primarily among adults: stigma, access to care, denial, drug side effects, lack of appreciation that drugs can help persons who are asymptomatic, depression, substance use, inattentive parenting, illness or death of a mother, health system disarray, poverty, transportation, and others.…”

Section: Discussionmentioning

confidence: 99%

Mortality in Children with Human Immunodeficiency Virus Initiating Treatment: A Six-Cohort Study in Latin America

Luque¹,

Jenkins

Shepherd

et al. 2017

The Journal of Pediatrics

View full text Add to dashboard Cite

Objectives To assess the risks of and factors associated with mortality, loss to followup, and changing regimens after perinatally HIV-infected children initiate combination antiretroviral therapy (cART) in Latin America and the Caribbean. Study design This 1997–2013 retrospective cohort study included 1174 ART-naïve perinatally-infected children who started cART age<18 years (median 4.7 years; interquartile range [IQR] 1.7–8.8) at one of six cohorts from Argentina, Brazil, Haiti, and Honduras, within the Caribbean, Central and South America Network for HIV Epidemiology (CCASAnet). Median follow-up was 5.6 years (interquartile range [IQR] 2.3 to 9.3). Study outcomes were all-cause mortality, loss to followup, and major changes/interruption/stopping of cART. We used Cox proportional hazards models stratified by site to examine the association between predictors and times to death or changing regimens. Results Only 52% started cART <5 years of age; 19% began a protease inhibitor. At cART initiation, median CD4 count was 472 cells/mm3 (IQR: 201–902); median CD4% was 16% (IQR:10–23). Probability of death was high in the first year of cART: 0.06 (95% confidence interval [CI] 0.04–0.07). Five years after cART initiation, the cumulative mortality incidence was 0.12 (CI 0.10–0.14). Cumulative incidences for loss to followup and regimen change after five years were 0.16 (CI 0.14–0.18) and 0.30 (CI 0.26–0.34), respectively. Younger children had the highest risk of mortality, whereas older children had the highest risk of being lost to followup or changing regimens. Conclusions Innovative clinical and community approaches are needed for quality improvement for HIV pediatric care in the Americas.

show abstract

Section: Discussionmentioning

confidence: 99%

Mortality in Children with Human Immunodeficiency Virus Initiating Treatment: A Six-Cohort Study in Latin America

Luque¹,

Jenkins

Shepherd

et al. 2017

The Journal of Pediatrics

View full text Add to dashboard Cite

show abstract

“…Youth infected with HIV are at increased risk of developmental and neuropsychological disturbances due to both, the direct effects of the HIV virus on brain structures involved in the regulation of emotion, behavior, and cognition and the indirect effects of social stressors, poverty, illness and trauma [47–49]. These disadvantages can seriously undermine academic and social achievement and therefore require urgent attention [50–52]. Following the scale-up of antiretroviral therapy supported by PEPFAR, survival of perinatally-infected children in sub-Saharan Africa has dramatically improved [53, 54], increasing the population of HIV+ adolescents.…”

Section: Introductionmentioning

confidence: 99%

“…Cognitive, psychiatric, and behavioral (neuropsychological) disorders are emerging as a major concern in HAART-treated perinatally infected children as they progress into adolescence. Such problems can seriously undermine academic and social achievement and therefore require urgent attention [50–52]. There is emerging data on poor academic performance by HIV infected children, with a significant number of children experiencing delay in achieving academic targets.…”

Section: Introductionmentioning

confidence: 99%

CNS Impact of Perinatal HIV Infection and Early Treatment: the Need for Behavioral Rehabilitative Interventions Along with Medical Treatment and Care

2016

View full text Add to dashboard Cite

There is growing concern that although the more severe forms of HIV associated neurologic deficits are reduced following highly active anti-retroviral therapy (HAART), mild to moderate cognitive disorders may persist for years after HAART initiation and this may occur despite complete plasma viral suppression. According to the UNAIDS 2014 report, there were 3.2 million children living with HIV around the world at the end of 2013 and 91% of these resided in sub-Sahara Africa. In the same year only 24% of children who needed antiretroviral treatment (ART) received it and 190,000 children died of AIDS-related illnesses. We propose that behavioral interventions are needed in combination with medical treatment and care in order to fully address the needs of children and adolescents in Africa living with HIV. In early childhood, caregiver training programs to enhance the developmental milieu of the child with HIV can enhance their cognitive and social development, and that such interventions are both feasible and well-accepted by the local population. For school-age children, computerized cognitive rehabilitation training can be an entertaining and engaging way to improve attention, working memory, and problem solving skills for children with HIV. Further dissemination and implementation science work is needed for arriving at cost effective strategies for scaling up such behavioral interventions in African resource-constrained settings, given that the vast majority of HIV-affected children and youth worldwide presently live in sub-Sahara Africa.

show abstract

“…In Ghana the prevalence of HIV in young people from 15-24 years is 1.2% [2]. Currently, children infected with HIV through mother-to-child transmission once diagnosed and in care, live longer and reach adolescence because of greater access to antiretroviral therapy (ART) in the past decade in West Africa [3, 4]. Thus, with the start of national programme for providing care and free highly active antiretroviral therapy (HAART) to children, there has been a significant reduction in morbidity and mortality of HIV infected children and more of them are surviving through childhood into adolescence with improved quality of life [3].…”

Section: Introductionmentioning

confidence: 99%

Knowledge and disclosure of HIV status among adolescents and young adults attending an adolescent HIV clinic in Accra, Ghana

et al. 2014

View full text Add to dashboard Cite

BackgroundIn Ghana it is estimated that 1.2% of HIV infections occur in young people aged 15-24 but the representation in our clinics is small. Adherence to treatment, appointment keeping and knowledge of HIV status remains a challenge. Disclosure has been shown to result in better adherence to therapy, good clinical outcomes, psychological adjustment and reduction in the risk of HIV transmission when the young person becomes sexually active. A baseline study was conducted to ascertain if adolescents and young adults knew their HIV status and their knowledge on HIV. Informed consent and assent were obtained from willing participants. Self-administered questionnaires on general knowledge of HIV, HIV treatment and disclosure were collected and analyzed.ResultsThirty-four young persons participated in the study. The mean age was 16.9 ± SD 2.5 and 62% (21/32) were female. All of them were still in school. Eighty-five percent were aware that young people their age could fall sick, 91% had heard of HIV, 70% knew someone with HIV and 45% thought that adolescents were not at risk of HIV. On modes of HIV transmission, 66.7% knew HIV was transmitted through sex and 63.6% knew about mother to child transmission. Fifty three percent (18/34) knew their HIV status, 50% (17/34) were on antiretroviral and 35% (6/17) of them admitted to missing ARV doses. One person who said he was HIV negative and another who did not know his status were both on ARVs.ConclusionDisclosure of HIV status to adolescents and young people is dependent on a complex mix of factors and most practitioners recommend an age and developmentally appropriate disclosure. Thus it is highly individualized. The knowledge and awareness of HIV was 91% compared to 97% of adults in the most recent Ghana Demographic and Health Survey however only about two thirds had acceptable in depth knowledge on HIV. Only half knew their HIV status which was not the best considering their ages. There is the need to strengthen education to young persons with HIV, support adhere to ARVs for better outcomes and assist care givers to disclose HIV status to them.

show abstract

Optimizing antiretroviral therapy in adolescents with perinatally acquired HIV-1 infection

Cited by 34 publications

References 107 publications

Mortality in Children with Human Immunodeficiency Virus Initiating Treatment: A Six-Cohort Study in Latin America

Mortality in Children with Human Immunodeficiency Virus Initiating Treatment: A Six-Cohort Study in Latin America

CNS Impact of Perinatal HIV Infection and Early Treatment: the Need for Behavioral Rehabilitative Interventions Along with Medical Treatment and Care

Knowledge and disclosure of HIV status among adolescents and young adults attending an adolescent HIV clinic in Accra, Ghana

Contact Info

Product

Resources

About