A study of HIV-infected adolescents in Montreal, Canada, has found that more than two-thirds of the young people were failing treatment when they transferred from pediatric to adult healthcare. The findings, which are consistent with earlier reports from the United Kingdom, Ireland and France, indicate that young HIV patients face serious issues with respect to drug resistance and immunodeficiency in their future therapeutic options.
Researchers, led by Valérie Lamarre of Université de Montréal, examined medical records of 45 teenagers who segued to adult care between June 1999 and May 2011. Their average age at the time of transfer was 18.1 years, and most of the patients acquired HIV from their mothers. All but two of the young were treated with antiretroviral therapy, but 32 of them were initially exposed to monotherapy or bitherapy before combined antiretroviral therapy (cART) became available. Eleven patients received cART from the start.
When they switched to adult healthcare, 26 of the 45 teenagers had detectable viremia. Thirteen, all of whom were first treated with monotherapy or bitherapy, had CD4 T-cell counts less than 200 cells/μl. Of 38 children who had undergone genotypic drug-resistance testing, 28 were resistant to at least one antiretroviral drug, and 12 patients were resistant to at least one drug in each of the major classes of antiretroviral agents.
‘That monotherapy and bitherapy treated patients from early in the epidemic fared poorly compared with adolescents who received only cART was no surprise,’ Lamarre says. However, although cART works very well on adolescents, compliance is a major issue. ‘The problem is getting them to take (the drugs),’ Lamarre says. ‘Furthermore, despite being from the cART era, many of our current adolescents already harbor resistance to non-nucleoside reverse-transcriptase inhibitors from difficulties with taking medication when they were young children, thus, taking away the only current option of an easy-to-take, once-a-day regimen.’
Van der Linden D, Lapointe N, Kakkar F, Ransy DG, Motorina A, Maurice F, et al. The young and the resistant: HIV-infected adolescents at the time of transfer to adult care. J Ped Infect Dis 2012 doi: 10.1093/jpids/pis106 First published online: 19 December 2012.
Conflicts of interest
There are no conflicts of interest.