Adolescents and HIV

Outcome of HAART in HIV-1 Infected Youth

Relevance for Title IV Providers: Growing numbers of adolescents are becoming infected with HIV through high-risk behaviors. Our current understanding of adolescent response to ARV therapy is limited.

Study Question(s): How does treatment with HAART affect viral load levels and CD4 counts in HIV-infected youth?

Study Participants: 120 HIV-positive adolescents, infected through high-risk behaviors, who began receiving highly active antiretroviral therapy (HAART). About half the participants were female, and most (over 90%) were between 15-20 years of age and either of African-American or Hispanic race/ethnicity. About 4/5 of the teens reported being exposed to HIV through sexual contact.

Study Methods: Subjects were enrolled at 28 sites of the Pediatric AIDS Clinical Trials Group (PACTG) and were followed at 4-week intervals. A self-report tool was used to record adherence, or the number of doses missing from each medication during three days before each visit.

Study Findings: After 16-24 weeks of HAART, 59% of the teens had undetectable viral loads, according to repeat measurements. Youth also experienced improvements in immune function, such as increases in CD4 counts and improvement in some other immunological indicators. Youth who came to all study visits, and reported taking all medicines for the previous three days, were more likely to have undetectable viral loads than youth with lower levels of adherence.

Limitations: The study used a self-report for medication adherence. Ongoing studies are investigating the degree of adherence necessary to achieve improvement in the viral load.

Lessons Learned: HAART treatment is effective in reducing viral load and improving immune function in adolescents. Teens treated with HAART are less likely to reach undetectable viral loads than adults - a problem that appears to be related to lack of adherence.

Implications for Title IV Providers: Treatment outcomes in teens are related to consistent medication use. Title IV providers need to develop creative strategies to assist adolescents with medication adherence. This may require providing access to professional counseling and mental health services to help teens deal with the compounding issues of psychological stress, that ultimately affect adherence to HAART and therefore its effectiveness in halting disease progression.

Source: Flynn PM, Rudy BJ, Douglas SD, Lathey J, Spector SA, Martinez J, Silio M, Belzer M, Friedman L, D'Angelo L, McNamara J, Hodge J, Hughes MD, Lindsey JC. Virologic and immunologic outcomes after 24 weeks in HIV type 1-infected adolescents receiving highly active antiretroviral therapy. Pediatric AIDS Clinical Trial Group 381 Study Team. Journal of Infectious Diseases. 2004 Jul 15;190(2):271-9.