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A Longitudinal Study of Behavioral Risk, Adherence, and Virologic Control in Adolescents Living With HIV in Asia

Ross, Jeremy L., MBBS, MSca; Teeraananchai, Sirinya, PhD, MSb; Lumbiganon, Pagakrong, MD, MScc; Hansudewechakul, Rawiwan, MDd; Chokephaibulkit, Kulkanya, MDe; Khanh, Truong Huu, MDf; Van Nguyen, Lam, MD, MScg; Mohamed, Thahira A Jamal, MBBS, MMedh; Yusoff, Nik Khairulddin Nik, MBBSi; Fong, Moy Siew, MBBSj; Prasitsuebsai, Wasana, MDb; Sohn, Annette H., MDa; Kerr, Stephen J., PhD, MIPH, BPharmb,k

JAIDS Journal of Acquired Immune Deficiency Syndromes: June 1, 2019 - Volume 81 - Issue 2 - p e28–e38
doi: 10.1097/QAI.0000000000002008

Background: Adolescents living with HIV (ALHIV) have poorer adherence and clinical outcomes than adults. We conducted a study to assess behavioral risks and antiretroviral therapy outcomes among ALHIV in Asia.

Methods: A prospective cohort study among ALHIV and matched HIV-uninfected controls aged 12–18 years was conducted at 9 sites in Malaysia, Thailand, and Vietnam from July 2013 to March 2017. Participants completed an audio computer-assisted self-interview at weeks 0, 48, 96, and 144. Virologic failure (VF) was defined as ≥1 viral load (VL) measurement >1000 copies/mL. Generalized estimating equations were used to identify predictors for VF.

Results: Of 250 ALHIV and 59 HIV-uninfected controls, 58% were Thai and 51% females. The median age was 14 years at enrollment; 93% of ALHIV were perinatally infected. At week 144, 66% of ALHIV were orphans vs. 28% of controls (P < 0.01); similar proportions of ALHIV and controls drank alcohol (58% vs. 65%), used inhalants (1% vs. 2%), had been sexually active (31% vs. 21%), and consistently used condoms (42% vs. 44%). Of the 73% of ALHIV with week 144 VL testing, median log VL was 1.60 (interquartile range 1.30–1.70) and 19% had VF. Over 70% of ALHIV had not disclosed their HIV status. Self-reported adherence ≥95% was 60% at week 144. Smoking cigarettes, >1 sexual partner, and living with nonparent relatives, a partner or alone, were associated with VF at any time.

Conclusions: The subset of ALHIV with poorer adherence and VF require comprehensive interventions that address sexual risk, substance use, and HIV-status disclosure.

aTREAT Asia/amfAR, The Foundation for AIDS Research, Bangkok, Thailand;

bThe HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), The Thai Red Cross AIDS Research Centre, Bangkok, Thailand;

cFaculty of Medicine, Srinagarind Hospital, Khon Kaen University, Khon Kaen, Thailand;

dChiangrai Prachanukroh Hospital, Chiang Rai, Thailand;

eFaculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand;

fChildren's Hospital 1, Ho Chi Minh City, Vietnam;

gNational Hospital of Pediatrics, Hanoi, Vietnam;

hPediatric Institute, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia;

iHospital Raja Perempuan Zainab II, Kelantan, Malaysia;

jHospital Likas, Kota Kinabalu, Malaysia; and

kFaculty of Medicine, Chulalongkorn University, Bangkok, Thailand.

Correspondence to: Jeremy L. Ross, MBBS, MSc, TREAT Asia/amfAR—The Foundation for AIDS Research, 388 Sukhumvit Road, Suite 2104, Klongtoey, Bangkok 10110, Thailand (e-mail:

Supported by a grant to amfAR, The Foundation for AIDS Research from the U.S. National Institutes of Health's National Institute of Allergy and Infectious Diseases, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Cancer Institute, National Institute of Mental Health, and National Institute on Drug Abuse as part of the International Epidemiology Databases to Evaluate AIDS (IeDEA; U01AI069907), and additional support from LIFE+, Austria. The content of this publication is solely the responsibility of the authors and does not necessarily represent the official views of any of the institutions mentioned above.

The authors have no conflicts of interest to disclose.

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Received October 11, 2018

Accepted January 24, 2019

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