Adolescents with perinatally-acquired HIV need transitional care

Poor virologic profiles, lack of adherence, drug resistance, high risk behavior common in this patient population.

Issue: December 2007

SAN DIEGO — Physicians should consider treatment history, resistance and psychosocial factors when treating adolescents with perinatally-acquired HIV, according to researchers who examined HIV treatment in adolescent patients.

Adolescents with HIV have problems unique and separate from the adult HIV population and should not be treated with traditional adult care if possible, the researchers said.

“Do not dismiss them as stupid teenagers, because the threats to public health are tremendous,” said Christos Karatzios, MD, assistant professor of pediatrics in the division of infectious diseases at Montreal Children’s Hospital of the McGill University Health Center. “A lot of these patients are not psychologically ready for adult treatment.”

Karatzios presented study results at the 45th Annual Meeting of the Infectious Diseases Society of America, held here in October. He conducted the study with colleagues from the University of Miami Miller School of Medicine.

The study results demonstrated that increased high risk behavior, poor virologic profiles and lack of adherence were common among adolescent patients with perinatally-acquired HIV. Recommendations for improved adolescent HIV care include providing more tertiary and transitional services between adolescent and adult care to help younger patients manage the unique issues.

Treatment considerations

Transferring patients with HIV out of pediatric care into adult care too early can be difficult for this patient population.

“Once you are an adult, physicians will not chase after you as much as a pediatrician will,” Karatzios said. “The patients suddenly go from being pampered to being treated in adult care. So they do not show up for visits and then if they are still alive five years down the line, they might trickle back into the system.”

For any patients born before 1996, when highly active antiretroviral treatments were introduced, physicians should note past monotherapy and resistance. “These patients have 18 years of infection under them and the virus has mutated since,” Karatzios said.

Physicians should also consider adherence as an exacerbated issue in adolescents who were born with HIV. Both bad-tasting medications and side effects of treatment leave the adolescent with treatment decisions they may be ill-equipped to make.

“If left to their own volition, many adolescent patients will not take their medications and then we wind up with 18-year-old kids with multi-drug resistant HIV that they will transmit to their peers,” Karatzios said. “They don’t disclose their HIV status, so we have the potential for a massive problem.”

A retrospective chart review on patients (n=165), all aged 13 to 24 years, was conducted from Jan. 1 through Dec. 31, 2005. Patients were 96% non-white and 46% were male. Median patient age was 16 years. Ninety-five percent were vertically infected.

Clinical patient information gathered for analysis included HIV sequelae, viral load, CD4 count, antiretroviral drug treatments and HIV resistance.

Half of patients studied were in the twenty-fifth percentile or lower for height and 26% of patients were in the seventy-fifth percentile or higher for weight.

Ninety-three percent of patients were on antiretroviral treatment of three-drug protease inhibitor-based therapy (53%) or once daily therapy (24%). Major resistance was seen in all antiretroviral treatments except for protease inhibitors.

Thirty-four percent of patients had poor mental health. Fifty-nine percent of patients did not live with their biological parents and 79% had one deceased parent. Of sexually active patients, 37% reported they did not use condoms and 63% reported they did not disclose their HIV status. Two patients had STDs and two became pregnant during the study period. – by Kirsten H. Ellis

For more information:

Karatzios C, Marin MY, Wilkinson JD, et al. The clinical and psychosocial characteristics of adolescents with HIV infection acquired early in life. #943. Presented at: The 45th Annual Meeting of the Infectious Diseases Society of America; Oct. 4-7, 2007; San Diego.