Survival, plasma HIV-1 RNA concentrations and drug resistance in HIV-1-infected Haitian adolescents and young adults on antiretrovirals

Abstract

Objective To assess outcomes after antiretroviral therapy (ART) in adolescents and youth in Haiti, a country with a generalized epidemic of infection with HIV-1. Methods An assessment was made of survival, plasma HIV-1 ribonucleic acid (RNA) concentrations and HIV-1 drug resistance patterns after 12 months of ART in patients aged 13-25 years who presented to a clinic in Port-au-Prince, Haiti, with AIDS between 1 March 2003 and 31 December 2005. Participants received ART in accordance with WHO guidelines. Kaplan-Meier analysis was used to estimate survival probabilities and their 95% confidence intervals (CI) for the period from ART initiation to death. Findings Of a total of 146 patients, 96 (66%) were female; the median CD4+ T-cell count at baseline was 129 cells/ml. By Kaplan-Meier analysis, 13% of the patients had died at 12 months, 17% at 24 months and 20% at 36 months. A plasma HIV-1 RNA concentration ≥ 50 copies/ml was seen in 40 (51%) of 79 patients 12 months after treatment initiation and was associated with poor ART adherence. Among 29 patients with > 1000 copies/ml at 12 months, resistance mutations to non-nucleoside reverse transcriptase inhibitors (NNRTIs) were detected in 23 cases (79%); to both NNRTIs and lamivudine in 21 (72%) cases; and to NNRTIs, lamivudine and other nucleoside reverse transcriptase inhibitors in 10 (35%) cases. One hundred and six participants (73%) reported sexual intercourse without condoms, and 35 of the 96 women (36%) were pregnant during follow-up. Conclusion Adolescents and youth with AIDS receiving ART are at risk of virologic failure and disease progression and can therefore transmit HIV-1 to sexual partners and infants. Strategies to target the special needs of this age group are urgently needed.

Perinatally acquired HIV infection in adolescents from sub-Saharan Africa: a review of emerging challenges

“…110–112 Likewise, when compared with younger children and adults, HIV-infected adolescents and young adults consistently have disproportionately higher rates of poor drug adherence and virological failure. 113–117 In a study of 154 adolescents and 7622 adults, the rate of optimum treatment adherence declined over time, from 21% at 6 months for adolescents (compared with 41% for adults) to 7% at 24 months (compared with 21%); furthermore, adolescents had a shorter time to viral rebound and were less likely to achieve long-term immunological recovery than were adult patients. 113 …”

“…Additionally, the risk of onward transmission of HIV to a sexual partner is high during adolescence. 117 Thus, maintaining adherence during adolescence is crucial not only to ensure sustainability of treatment success but also to prevent HIV transmission. 124 An evidence base for effective interventions to support adherence among adolescents in low-income settings is absent.…”

HIV Status Disclosure and Retention in Care in HIV-Infected Adolescents on Antiretroviral Therapy (ART) in West Africa

“…Virological failure has also been observed among adolescents [5], 6,7 such as in a US series where it was observed in 67% of 154 adolescents, mainly associated with the lack of adherence and suboptimal ART use [8]. Treatment adherence may be one of the critical issues for therapeutic long-term success in adolescents.…”

Impact of a youth‐friendly HIV clinic: 10 years of adolescent outcomes in Port‐au‐Prince, Haiti

“…Considering the high national adolescent fertility rate (69 per 1000 adolescents and up to 300 per 1000 in the poorest populations), HIV-positive adolescents are at high risk for transmitting HIV to their partners and infants [7]. HIV-positive adolescents must be tested, linked to care and retained in HIV care in order to optimize their own health and reduce further transmission [8,9]. …”