Long-Term Observation of Adolescents Initiating HAART Therapy: Three-Year Follow-Up

Abstract

The PACTG 381 cohort included 120 adolescents infected via high-risk behaviors and treated with at least two NRTIs plus either a protease inhibitor or an efavirenz-containing HAART regimen. After 24 weeks of therapy, only 69 of 118 (59%) evaluable subjects had undetectable viral loads. We now present findings of the study after 3 years of follow-up. Virologic, immunologic, and treatment information were collected from subjects every 12 weeks beyond the first 24 weeks of therapy through 156 weeks. Of the 120 subjects starting HAART, 44 (37%) stayed on study treatment for the 3 years of observation. Twenty-nine (24%) subjects reached and maintained undetectable viral loads. Poorer adherence (p = 0.016), higher baseline viral load (p = 0.010), and CD8 naive counts (p = 0.034) predicted virologic failure. Immunologic measurements improved from entry to the end of follow-up in the subjects with undetectable viral loads. CD4 counts at the end of study were not significantly different from HIV-uninfected youth, but CD4%, CD8 counts and percent, and CD8 activation markers remained significantly different. Adolescents infected with HIV via high-risk behaviors have less than optimal responses to HAART therapy with only 24% achieving and maintaining undetectable viral loads over 3 years. Immunologic improvement was demonstrated and CD4 counts in subjects with virologic control reached levels in HIV-uninfected adolescents. Interventions, especially those focused on adherence, are necessary to improve HAART outcomes in adolescents.

Short-Cycle Therapy in Adolescents after Continuous Therapy with Established Viral Suppression: The Impact on Viral Load Suppression

“…[3][4][5] Data from the REACH Project demonstrated that long-term adherence is a particular challenge for adolescents. 22 We found very high rates of adherence in subjects on our study placed onto SCT.…”

“…2 Research on the impact of highly active antiretroviral therapy (HAART), especially management strategies, is limited in this population. [3][4][5] A number of management strategies have been tried to limit antiretroviral exposure, enhance adherence, limit medication-associated toxicity, and improve quality of life. These strategies include CD4-guided treatment interruptions, structure treatment interruptions, and short-cycle therapy.…”

Psychosocial Support for Youth Living With HIV

“…8,9 Similar findings among adolescents and young adults who acquired HIV horizontally are reported, with as few as 24% in 1 study achieving virologic suppression at 3 years after initiation of cART. 10 Such observations reinforce the need to design, implement, and evaluate strategies to increase and sustain adherence to therapy in this group. Interventions must factor the adolescents' stage of development, education level, health literacy and coping ability, and structural environment.…”

Using CD4 Percentage and Age to Optimize Pediatric Antiretroviral Therapy Initiation

“…In PENPACT-1, viral failure was worse at age extremes, consistent with studies finding poor viral suppression at younger ages 6,19 and myriad adherence difficulties in adolescents. 7,54 …”